Treating refractory migraine

ABSTRACT

Disclosed herein are methods of treating or reducing incidence of migraine and/or at least one secondary symptom associated with refractory migraine in a subject having refractory migraine comprising administering to the subject a monoclonal antibody that modulates the CGRP pathway. Compositions for use in the disclosed methods are also provided. Antagonist antibody G1 and antibodies derived from G1 directed to CGRP are also described.

CROSS REFERENCE TO RELATED APPLICATIONS

This application continuation application of U.S. application Ser. No.16/508,574, filed on Jul. 11, 2019, which is a continuation applicationof U.S. application Ser. No. 15/712,444, filed on Sep. 22, 2017, nowU.S. Pat. No. 10,392,434, which claims the benefit of priority of U.S.Application No. 62/399,180, filed on Sep. 23, 2016 and U.S. ApplicationNo. 62/558,557, filed on Sep. 14, 2017. The contents of these priorapplications are hereby incorporated by reference in their entireties.

BACKGROUND

Migraine is a prevalent neurological condition characterized by attacksof headache and associated symptoms, such as nausea, vomiting,photophobia, and/or phonophobia. In US and Western Europe, the overallprevalence of migraine sufferers is 11% of the general population (6%males; 15-18% females). The two most common forms of migraine, migrainewithout aura and migraine with aura, occur on less than 15 days permonth and are referred to as episodic forms of migraine (EM) (Lipton etal, Neurology 68(5):343-349, 2007). However, 3% to 6% of individualswith EM evolve, in any given year, to a significantly more disablingcondition called chronic migraine (CM) (Scher et al, Pain106(1-2):81-89, 2003). Individuals with CM present with headaches of anyseverity on 15 or more days per month and have full-blown migraine on atleast 8 days per month. A sizable proportion of individuals with CMexperience daily headaches and, therefore, faces considerable disability(Bigal and Lipton, Neurology 71(11):848-855, 2008).

Preventive drug treatment of migraine may be appropriate in a number ofinstances, including where frequency of attacks per month is two orhigher, or where a patient's quality of life is severely impaired (Everset al., Europ. J. Neurol. 16:968-981, 2009). A number of drugs fromdifferent pharmacological categories (e.g. beta blockers,anticonvulsants) have been approved for migraine prevention or haveclass A evidence to support their use. However, patient response andtolerance to some of these medications varies, and compliance andadherence to these medications can be poor (Puledda et al., J. Neurol.March 20. doi: 10.1007/s00415-017-8434, 2017).

Calcitonin gene-related peptide (CGRP) is a neuropeptide that has beenfound to be involved in migraine processes, both centrally andperipherally (Eftekhari and Edvinsson, Ther. Adv. Neurol. Disord.3(6):369-378, 2010, Olesen, Cephalagia 31(5):638, 2011). Jugular levelsof CGRP are increased during migraine attacks, and intravenous (iv) CGRPadministration induces migraine-like headache in most individuals withmigraine (Ashina et al., Neurology 55(9):1335-1340, 2000, Hansen et al.,Cephalagia 30(1):1179-1186, 2010). CGRP is involved in thepathophysiology of migraine at all levels, peripherally (vasodilation,inflammation, and protein extravasation), at the trigeminal ganglion,and inside the brain (Ho et al., Nat. Rev. Neurol. 6(10):573-582, 2010).Studies have shown that inhibition of CGRP or antagonizing CGRP receptorhas demonstrated efficacy in the treatment of EM (Bigal et al., LancetNeurol. 14:1081-1090, 2015a, Hewitt et al., Cephalagia 31(6):712-722,2011, Ho et al., Lancet 372(9656):2115-2123, 2008, Olesen et al., N.Engl. J. Med. 350(11):1104-1110, 2004) and CM (Bigal et al., LancetNeurol. 14:1091-1100, 2015b).

Monoclonal antibodies that modulate the CGRP pathway thus represent aclass of promising therapeutic candidates for patients who failed priorpreventative treatment for CM and EM.

SUMMARY

Disclosed herein are anti-CGRP antagonist antibodies and methods ofusing the same for preventing, treating, or reducing incidence ofmigraine in a subject having refractory migraine (i.e., a subject whodoes not respond favorable to prior preventative migraine treatments).Also disclosed herein are methods of preventing, treating, or reducingincidence of migraine in a subject having refractory migraine comprisingadministering to the subject a monoclonal antibody that modulates theCGRP pathway.

Methods of preventing, treating, or reducing incidence of at least onesecondary symptom associated with refractory migraine in a subjectcomprising administering to the subject a monoclonal antibody thatmodulates the CGRP pathway are also provided. In some embodiments, theamount of the monoclonal antibody administered to the patient can beabout 225 mg to about 1000 mg, e.g., about 675 mg or about 900 mg.Accordingly, in some aspects, the methods of preventing, treating, orreducing incidence of migraine in a subject having refractory migrainecan comprise administering to the subject a monoclonal antibody thatmodulates the CGRP pathway, wherein the amount of the monoclonalantibody administered to the patient can be about 225 mg to about 1000mg, e.g., about 675 mg or about 900 mg. In other aspects, the methods ofpreventing, treating, or reducing incidence of at least one secondarysymptom associated with refractory migraine in a subject can compriseadministering to the subject a monoclonal antibody that modulates theCGRP pathway are also provided, wherein the amount of the monoclonalantibody administered to the patient can be about 225 mg to about 1000mg, e.g., about 675 mg or about 900 mg. In one embodiment, the dosingregimen comprises administering an initial antibody dose (or startingantibody dose) of about 675 mg subcutaneously, followed by a monthlyantibody dose of about 225 mg subcutaneously for, e.g., about twomonths, three months, four months, five months, six months, sevenmonths, eight months, nine months, ten months, 11 months, or 12 months,or even a period of greater than one year (e.g., 18 months, two years,or three years). Yet another dosing regimen comprises administering aninitial or starting dose of about 900 mg intravenously in an infusionover about 60 minutes, followed by doses of about 900 mg administeredintravenously in an infusion over about 60 minutes every quarter for,e.g., about one year, two years, three years, four years, or five years.Yet another dosing regimen comprises administering an initial orstarting dose of about 675 mg administered subcutaneously, followed bydoses of about 675 mg administered subcutaneously every quarter for,e.g., about one year, two years, three years, four years, or five years.

Suitable administration schedules include, but are not limited to,monthly or quarterly doses, or a single dose. In some embodiments, themonoclonal antibody can be administered monthly. For example, themonoclonal antibody can be administered monthly for 1, 2, 3, 4, 5, 6, 7,8, 9, 10, 11, 12, or more months. In some aspects, the monoclonalantibody can be administered monthly for three or more months. Whenadministered monthly, the dose of the monoclonal antibody administeredto the patient can be about 225 mg to about 900 mg.

The monoclonal antibody can be administered as a single dose. Whenadministered as a single dose, the dose of the monoclonal antibodyadministered to the patient can be about 675 mg to about 1000 mg.

The treating or reducing can comprise reducing the number of headachehours of any severity, reducing the number of monthly headache days ofany severity, reducing the use of any acute headache medications (e.g.,migraine-specific acute headache medications), reducing a 6-itemHeadache Impact Test (HIT-6) disability score, improving 12-Item ShortForm Health Survey (SF-12) score (Ware et al., Med Care 4:220-233,1996), reducing Patient Global Impression of Change (PGIC) score (Hurstet al., J Manipulative Physiol Ther 27:26-35, 2004), improving SportConCuSSion ASSeSment tool 3 (SCAT-3) score (McCrory et al. BritishJournal of Sports Medicine 47:263-266, 2013), or any combinationthereof. In some embodiments, the number of monthly headache days can bereduced for at least seven days after a single administration.

In some embodiments, monthly headache hours experienced by the subjectafter said administering is reduced by 40 or more hours (e.g., 45, 50,55, 60, 65, 70, 75, 80, or more) from a pre-administration level in thesubject. Monthly headache hours may be reduced by more than 60 hours. Insome embodiments, monthly headache hours experienced by the subjectafter said administering are reduced by 25% or more (e.g., 30%, 35%,40%, 45%, 50%, or more) relative to a pre-administration level in thesubject. Monthly headache hours may be reduced by 40% or more. In someembodiments, monthly headache days experienced by the subject after saidadministering is reduced by three or more days (e.g., 3, 4, 5, 6, 7, 8,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more days) from apre-administration level in the subject. In some embodiments, the numberof monthly headache days can be reduced by at least about 50% from apre-administration level in the subject. Thus, in some aspects, thenumber of monthly headache days can be reduced by at least about 50%, atleast about 55%, at least about 60%, at least about 65%, at least about70%, at least about 75%, at least about 80%, or at least about 90%.

In some embodiments, the administering can be subcutaneousadministration. In some embodiments, the administering can beintravenous administration. In some embodiments, the administering cancomprise utilizing a pre-filled syringe, pre-filled syringe with aneedle safety device, injection pen, or auto-injector comprising a doseof the monoclonal antibody. In some embodiments, the monoclonal antibodycan be formulated at a concentration of at least 150 mg/mL. In someembodiments, the monoclonal antibody can be administered in a volume ofless than 2 mL, e.g., about 1.5 mL.

In some embodiments, the method further comprises administering to thesubject a second agent simultaneously or sequentially with themonoclonal antibody. In an embodiment, the second agent is an acuteheadache treatment (e.g., a migraine-specific acute headache treatment).Accordingly, the second agent can be any of analgesics (e.g.,acetylsalicylic acid, ibuprofen, naproxen, diclofenac, paracetamol,acetylsalicylic acid plus paracetamol plus caffeine, metamizol,phenazon, or tolfenamic acid); antiemetics (e.g., metoclopramide ordomperidon); ergot alkaloids (e.g., ergotamine tartrate ordihydroergotamine); and triptans, i.e., 5-HT1 agonists (e.g.,sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan,eletriptan, or frovatriptan).

In some embodiments, monthly use of the second agent by the subject isdecreased by at least about 15%, e.g., at least 16%, 17%, 18%, 20%, 22%,25%, 28%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%,90%, or at least about 95%, after administering the monoclonal antibody.In some embodiments, the second agent is a triptan.

In some embodiments, the subject is a human.

The monoclonal antibody can be an anti-CGRP antagonist antibody. In someembodiments, the monoclonal antibody is a human or humanized monoclonalantibody. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6.

Also disclosed are methods of decreasing a number of monthly headachehours experienced by a subject having refractory migraine. In oneembodiment, the method comprises administering to the subject an amountof a monoclonal antibody that modulates the CGRP pathway, wherein themonoclonal antibody is in an amount effective to decrease the number ofmonthly headache hours by at least 20 (e.g., 25, 30, 35, 40, 45, 50, 55,60, 65, 70 or more headache hours) after a single dose. In someembodiments, the number of monthly headache hours is reduced by at leastabout 50 hours. In one embodiment, the method comprises administering tothe subject an amount of a monoclonal antibody that modulates the CGRPpathway, wherein the monoclonal antibody is in an amount effective todecrease the number of monthly headache hours by at least 15% (e.g.,20%, 25%, 30%, 35%, 40%, or more) after a single dose. In someembodiments, the number of monthly headache hours is reduced by at leastabout 30%. In some embodiments, the monoclonal antibody is an anti-CGRPantagonist antibody. In some embodiments, the amount of the monoclonalantibody administered to the patient is about 225 mg to about 1000 mg.In some embodiments, the monoclonal antibody is administered monthly. Insome embodiments, the monoclonal antibody is administered as a singledose. In some embodiments, the administering is subcutaneous orintravenous administration. In some embodiments, the monoclonal antibodyis formulated at a concentration of at least 150 mg/mL. In someembodiments, the monoclonal antibody is administered in a volume of lessthan 2 mL, e.g., about 1.5 mL. In some embodiments, the subject ishuman. In some embodiments, the monoclonal antibody is human orhumanized. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6.

Also disclosed are methods of decreasing a number of monthly headachedays experienced by a subject having refractory migraine. In oneembodiment, the method comprises administering to the subject an amountof a monoclonal antibody that modulates the CGRP pathway, wherein themonoclonal antibody is in an amount effective to decrease the number ofmonthly headache days by at least 3 (e.g., 3, 4, 5, 6, 7, 8, 9, 10, 11,12, 13, 14, 15, 16, 17, 18, 19, 20 or more headache days) after a singledose. In some embodiments, the number of monthly headache days isreduced by at least about 6 headache days. In some embodiments, thenumber of monthly headache days can be reduced by at least about 50%from a pre-administration level in the subject. Thus, in some aspects,the number of monthly headache days can be reduced by at least about50%, at least about 55%, at least about 60%, at least about 65%, atleast about 70%, at least about 75%, at least about 80%, or at leastabout 90%. In some embodiments, the monoclonal antibody is an anti-CGRPantagonist antibody. In some embodiments, the amount of the monoclonalantibody administered to the patient is about 225 mg to about 1000 mg.In some embodiments, the monoclonal antibody is administered monthly. Insome embodiments, the monoclonal antibody is administered as a singledose. In some embodiments, the administering is subcutaneous orintravenous administration. In some embodiments, the monoclonal antibodyis formulated at a concentration of at least 150 mg/mL. In someembodiments, wherein the monoclonal antibody is administered in a volumeof less than 2 mL, e.g., about 1.5 mL. In some embodiments, the subjectis human. In some embodiments, the monoclonal antibody is human orhumanized. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6.

Also disclosed are methods of decreasing use of any acute headachemedication in a subject having refractory migraine, comprisingadministering to the subject a monoclonal antibody (e.g., anti-CGRPantagonist antibody) that modulates the CGRP pathway, wherein themonoclonal antibody is in an amount effective to decrease monthly use ofthe headache medication by the subject by at least 15% (e.g., 20%, 25%,30%, 35%, 40%, or more). In some embodiments, the acute headachemedication is selected from the group consisting of 5-HT1 agonists,triptans, opiates, ergot alkaloids, and non-steroidal anti-inflammatorydrugs (NSAIDs). In some embodiments, the acute headache medication isselected from analgesics (e.g., acetylsalicylic acid, ibuprofen,naproxen, diclofenac, paracetamol, acetylsalicylic acid plus paracetamolplus caffeine, metamizol, phenazon, or tolfenamic acid); antiemetics(e.g., metoclopramide or domperidon); ergot alkaloids (e.g., ergotaminetartrate or dihydroergotamine); and triptans, i.e., 5-HT1 agonists(e.g., sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan,eletriptan, or frovatriptan). In some embodiments, the acute headachemedication is a triptan. In some embodiments, the amount of themonoclonal antibody administered to the patient is about 225 mg to about1000 mg, e.g., about 675 mg or about 900 mg. In some embodiments, themonoclonal antibody is administered monthly. In some embodiments, themonoclonal antibody is administered as a single dose. In someembodiments, the administering is subcutaneous or intravenousadministration. In some embodiments, the monoclonal antibody isformulated at a concentration of at least 150 mg/mL. In someembodiments, wherein the monoclonal antibody is administered in a volumeof less than 2 mL, e.g., about 1.5 mL. In some embodiments, the subjectis human. In some embodiments, the monoclonal antibody is human orhumanized. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6.

In one aspect, the invention provides a method of preventing, treating,or reducing incidence of migraine in a subject having refractorymigraine comprising subcutaneously administering to the subject aloading dose of a monoclonal antibody (e.g., monoclonalanti-CGRP-antagonist antibody) in an amount that modulates the CGRPpathway, wherein the amount of the monoclonal antibody is about 225 mgto about 1000 mg, e.g., about 675 mg (e.g., three subcutaneousinjections of 225 mg each), followed by monthly subcutaneous injectionsof about 100 mg to about 1000 mg, e.g., about 225 mg, for about one to12 consecutive months, e.g., five consecutive months.

In some embodiments, the methods include selecting a subject who doesnot respond favorably to a migraine treatment selected from the groupconsisting of topiramate, carbamazepine, divalproex sodium, sodiumvalproate, valproic acid, flunarizine, candesartan, pizotifen, amitriptyline, venlafaxine, nortriptyline, duloxetine, atenolol, nadolol,metoprolol, propranolol, bisopropol, timolol, and onabotulinumtoxinA. Insome embodiments, the methods include selecting a subject who does notrespond favorably to a migraine treatment selected from the groupconsisting of topiramate, carbamazepine, divalproex sodium, sodiumvalproate, flunarizine, pizotifen, am itriptyline, venlafaxine,nortriptyline, duloxetine, atenolol, nadolol, metoprolol, propranolol,timolol, and onabotulinumtoxinA. In some embodiments, the methodsinclude selecting a subject who does not respond favorably to a migrainetreatment selected from the group consisting of propranolol, metoprolol,atenolol, bisopropol, topiramate, amitriptyline, flunarizine,candesartan, onabotulinumtoxinA, and valproic acid. In some embodiments,the methods include selecting a subject who does not respond favorablyto a migraine treatment selected from propranolol/metoprolol,topiramate, flunarizine, valproate/divalproex, am itriptyline,venlafaxine, lisinopril, candesartan, and locally approved products(e.g. oxeterone or pizotifen). In other embodiments, the methods includeselecting a subject who does not respond favorably to one or moremigraine treatments of the following classes: beta-blockers,anticonvulsants, tricyclics, calcium channel blockers, angiotensin IIreceptor antagonists. For example, the subject may have documentedinadequate response (in a medical chart or by treating physician'sconfirmation) to at least two preventive medications (from differentclusters, as defined below). Or, the subject may have documentedinadequate response (in a medical chart or by treating physician'sconfirmation) to two to four classes of prior preventive medications(from, e.g., different clusters, as defined below). As another example,the subject may have documented inadequate response (in a medical chartor by treating physician's confirmation) to two to three classes ofprior preventive medications (from different clusters, as defined below)and a valrproate (e.g., divalproex sodium, sodium valproate, or valproicacid).

Inadequate response is defined as: no clinically meaningful improvementper treating physician's judgement, after at least three months oftherapy at a stable dose considered appropriate for migraine preventionaccording to accepted country guidelines, or when treatment has to beinterrupted because of adverse events that made it intolerable by thepatient or the drug is contraindicated or not suitable for the patient.The three month period may not apply if the drug is intolerable orcontraindicated or not suitable for the patient. For onabotulinumtoxinA,an inadequate response is defined as: no clinically meaningfulimprovement per treating physician's judgement, after at least sixmonths of therapy at a stable dose considered appropriate for migraineprevention according to accepted country guidelines, or when treatmenthas to be interrupted because of adverse events that made it intolerableby the patient. Or, if onabotulinumtoxinA is a previous preventativemedication, at least two sets of injections and three months should havepassed since the last set of injections.

In some embodiments, the clusters are as follows:

-   -   cluster A: topiramate, carbamazepine, divalproex sodium, and        sodium valproate    -   cluster B: flunarizine and pizotifen    -   cluster C: amitriptyline, venlafaxine, nortriptyline, and        duloxetine    -   cluster D: atenolol, nadolol, metoprolol, propranolol, and        timolol    -   cluster E: onabotulinumtoxinA

In some embodiments, the clusters are as follows:

-   -   cluster A: beta-blockers: propranolol, metoprolol, atenolol, and        bisopropol    -   cluster B: anticonvulsants: topiramate    -   cluster C: tricyclics: amitriptyline    -   cluster D: calcium channel blocker: flunarizine    -   cluster E: angiotensin II receptor antagonist: candesartan    -   cluster F: onabotulinumtoxinA    -   cluster G: valproic acid

Additional clusters (which may be included with either of the groups ofclusters above include:

-   -   cluster a: an angiotensin-converting enzyme (ACE) inhibitor,        such as lisinopril    -   cluster b: a benzocycloheptene-based drug, such as pizotifen    -   cluster c: an antidepressant, such as amitriptyline (Elavil),        trazodone (Desyrel), and imipramine (Tofranil), and venlafaxine    -   cluster d: an anticonvulsant such as phenytoin (Dilantin) or        carbamazepine (Tegretol)    -   cluster e: oxeterone

In one aspect, the invention provides a method of preventing, treating,or reducing incidence of migraine in a subject having refractorymigraine comprising administering to the subject a single dose of amonoclonal antibody (e.g., monoclonal anti-CGRP-antagonist antibody) inan amount that modulates the CGRP pathway, wherein the amount of themonoclonal antibody is about 225 mg to about 1000 mg, e.g., about 675 mgor about 900 mg. In an embodiment, the subject is refractory to at leasttwo different preventative treatments selected from topiramate,onabotulinumtoxinA, and valproic acid. In an embodiment, the subject isrefractory to preventative treatment with topiramate,onabotulinumtoxinA, and valproic acid.

In one aspect, the invention provides a method of preventing, treating,or reducing incidence of migraine in a subject having refractorymigraine comprising administering to the subject a monoclonal antibody(e.g., monoclonal anti-CGRP-antagonist antibody) in an amount thatmodulates the CGRP pathway, wherein the amount of the monoclonalantibody is about 225 mg to about 1000 mg, e.g., about 675 mg or about900 mg. In an embodiment, the subject is refractory to at least twodifferent preventative treatments selected from topiramate,onabotulinumtoxinA, and valproic acid. In an embodiment, the subject isrefractory to preventative treatment with topiramate,onabotulinumtoxinA, and valproic acid. In some embodiments, themonoclonal antibody is administered as a single dose.

In a further embodiment, the invention provides methods for preventing,treating, ameliorating, controlling, reducing incidence of, or delayingthe development or progression of migraine in an individual diagnosedwith refractory migraine (see, e.g., the criteria described herein)comprising administering to the individual an effective amount of ananti-CGRP antagonist antibody in combination with at least oneadditional acute headache medication or agent useful for treatingmigraine. Such additional agents include, e.g., 5-HT1-like agonists (andagonists acting at other 5-HT1 sites), triptans, opiates, ergotalkaloids, and non-steroidal anti-inflammatory drugs (NSAIDs). In someembodiments, the acute headache medication is selected from analgesics(e.g., acetylsalicylic acid, ibuprofen, naproxen, diclofenac,paracetamol, acetylsalicylic acid plus paracetamol plus caffeine,metamizol, phenazon, or tolfenamic acid); antiemetics (e.g.,metoclopramide or domperidon); ergot alkaloids (e.g., ergotaminetartrate or dihydroergotamine); and triptans, i.e., 5-HT1 agonists(e.g., sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan,eletriptan, or frovatriptan).

Non-limiting examples of 5-HT1 agonists that can be used in combinationwith an anti-CGRP antibody include a class of compounds known astriptans, such as sumatriptan, zolmitriptan, naratriptan, rizatriptan,eletriptan, almotriptan, and frovatriptan. Ergot alkaloids and relatedcompounds are also known to have 5-HT agonist activity and have beenused to treat headaches. Included among these compounds are ergotaminetartrate, ergonovine maleate, and ergoloid mesylates (e.g.,dihydroergocornine, dihydroergocristine, dihydroergocryptine, anddihydroergotamine mesylate (DHE 45)).

Non-limiting examples of NSAIDs (as an acute headache medication) thatcan be used in combination with an anti-CGRP antibody include aspirin,diclofenac, diflusinal, etodolac, fenbufen, fenoprofen, flufenisal,flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac,meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxaprozin,phenylbutazone, piroxicam, sulindac, tolmetin or zomepirac,cyclooxygenase-2 (COX-2) inhibitors, celecoxib; rofecoxib; meloxicam;JTE-522; L-745,337; NS398; or a pharmaceutically acceptable saltthereof.

In one embodiment, the anti-CGRP antagonist antibody used in any of themethods described above is any of the antibodies as described herein.

In some embodiments, the anti-CGRP antagonist antibody recognizes ahuman CGRP. In some embodiments, the anti-CGRP antagonist antibody bindsto both human α-CGRP and β-CGRP. In some embodiments, the anti-CGRPantagonist antibody binds human and rat CGRP. In some embodiments, theanti-CGRP antagonist antibody binds the C-terminal fragment having aminoacids 25-37 of CGRP. In some embodiments, the anti-CGRP antagonistantibody binds a C-terminal epitope within amino acids 25-37 of CGRP.

In some embodiments, the anti-CGRP antagonist antibody is a monoclonalantibody. In some embodiments, the anti-CGRP antagonist antibody ishumanized. In some embodiments, the antibody is human. In someembodiments, the anti-CGRP antagonist antibody is antibody G1 (asdescribed herein). In some embodiments, the anti-CGRP antagonistantibody comprises one or more CDR(s) (such as one, two, three, four,five, or, in some embodiments, all six CDRs) of antibody G1 or variantsof G1 shown in Table 6. In still other embodiments, the anti-CGRPantagonist antibody comprises the amino acid sequence of the heavy chainvariable region shown in FIG. 5 (SEQ ID NO:1) and the amino acidsequence of the light chain variable region shown in FIG. 5 (SEQ IDNO:2).

In some embodiments, the antibody comprises a modified constant region,such as a constant region that is immunologically inert (includingpartially immunologically inert), e.g., does not trigger complementmediated lysis, does not stimulate antibody-dependent cell mediatedcytotoxicity (ADCC), does not activate microglia, or having reduced oneor more of these activities. In some embodiments, the constant region ismodified as described in Eur. J. Immunol. (1999) 29:2613-2624; PCTApplication No. PCT/GB99/01441; and/or UK Patent Application No.9809951.8. In other embodiments, the antibody comprises a human heavychain IgG2 constant region comprising the following mutations: A330P331to S330S331 (amino acid numbering with reference to the wildtype IgG2sequence). Eur. J. Immunol. (1999) 29:2613-2624. In some embodiments,the heavy chain constant region of the antibody is a human heavy chainIgG1 with any of the following mutations: 1) A327A330P331 toG327S330S331; 2) E233L234L235G236 (SEQ ID NO:48) to P233V234A235 withG236 deleted; 3) E233L234L235 to P233V234A235; 4)E233L234L235G236A327A330P331 (SEQ ID NO:49) to P233V234A235G327S330S331(SEQ ID NO:50) with G236 deleted; 5) E233L234L235A327A330P331 (SEQ IDNO:51) to P233V234A235G327S330S331 (SEQ ID NO:50); and 6) N297 to A297or any other amino acid except N. In some embodiments, the heavy chainconstant region of the antibody is a human heavy chain IgG4 with any ofthe following mutations: E233F234L235G236 (SEQ ID NO:52) to P233V234A235with G236 deleted; E233F234L235 to P233V234A235; and 5228L235 toP228E235.

In still other embodiments, the constant region is aglycosylated forN-linked glycosylation. In some embodiments, the constant region isaglycosylated for N-linked glycosylation by mutating the oligosaccharideattachment residue (such as Asn297) and/or flanking residues that arepart of the N-glycosylation recognition sequence in the constant region.In some embodiments, the constant region is aglycosylated for N-linkedglycosylation. The constant region may be aglycosylated for N-linkedglycosylation enzymatically or by expression in a glycosylationdeficient host cell.

The binding affinity (K_(D)) of an anti-CGRP antagonist antibody to CGRP(such as human α-CGRP as measured by surface plasmon resonance at anappropriate temperature, such as 25 or 37° C.) can be about 0.02 toabout 200 nM. In some embodiments, the binding affinity is any of about200 nM, about 100 nM, about 50 nM, about 10 nM, about 1 nM, about 500pM, about 100 pM, about 60 pM, about 50 pM, about 20 pM, about 15 pM,about 10 pM, about 5 pM, or about 2 pM. In some embodiments, the bindingaffinity is less than any of about 250 nM, about 200 nM, about 100 nM,about 50 nM, about 10 nM, about 1 nM, about 500 pM, about 100 pM, orabout 50 pM. In some embodiments, the binding affinity is less thanabout 50 nM.

The anti-CGRP antagonist antibody may be administered prior to, during,and/or after a migraine in the subject having refractory migraine. Insome embodiments, the anti-CGRP antagonist antibody is administeredprior to the subject experiencing symptoms of a migraine. Administrationof an anti-CGRP antagonist antibody can be by any means known in theart, including: orally, intravenously, subcutaneously, intraarterially,intramuscularly, intranasally (e.g., with or without inhalation),intracardially, intraspinally, intrathoracically, intraperitoneally,intraventricularly, sublingually, transdermally, and/or via inhalation.Administration may be systemic, e.g., intravenously, or localized. Insome embodiments, an initial or starting dose and one or more additionaldoses are administered the same way, i.e., subcutaneously orintravenously. In some embodiments, the one or more additional doses areadministered in a different way than the initial dose, i.e., the initialdose may be administered intravenously and the one or more additionaldoses may be administered subcutaneously.

In another aspect, the invention provides use of an anti-CGRP antagonistantibody for the manufacture of a medicament for use in any of themethods described herein.

In another aspect, the invention provides a pharmaceutical compositionfor preventing, treating, or reducing migraine in a subject havingrefractory migraine comprising an effective amount of an anti-CGRPantagonist antibody, in combination with one or more pharmaceuticallyacceptable excipients.

In another aspect, the invention provides a kit for use in any of themethods described herein. In some embodiments, the kit comprises acontainer, a composition comprising an anti-CGRP antagonist antibodydescribed herein, in combination with a pharmaceutically acceptablecarrier, and instructions for using the composition in any of themethods described herein.

In some embodiments, the methods provided herein utilize anti-CGRPantagonist antibodies and polypeptides derived from antibody G1 or itsvariants shown in Table 6. Accordingly, in one aspect, the inventionprovides an antibody G1 (interchangeably termed “G1” and “TEV-48125”)that is produced by expression vectors having ATCC Accession Nos.PTA-6866 and PTA-6867. For example, in one embodiment is an antibodycomprising a heavy chain produced by the expression vector with ATCCAccession No. PTA-6867. In a further embodiment is an antibodycomprising a light chain produced by the expression vector with ATCCAccession No. PTA-6866. The amino acid sequences of the heavy chain andlight chain variable regions of G1 are shown in FIG. 5. Thecomplementarity determining region (CDR) portions of antibody G1(including Chothia and Kabat CDRs) are also shown in FIG. 5. It isunderstood that reference to any part of or entire region of G1encompasses sequences produced by the expression vectors having ATCCAccession Nos. PTA-6866 and PTA-6867, and/or the sequences depicted inFIG. 5. In some embodiments, the invention also provides antibodyvariants of G1 with amino acid sequences depicted in Table 6.

In some embodiments, the antibody comprises a V_(H) domain that is atleast 85%, at least 86%, at least 87%, at least 88%, at least 89%, atleast 90%, at least 91%, at least 92%, at least 93%, at least 94%, atleast 95%, at least 96%, at least 97% at least 98%, at least 99% or 100%identical in amino acid sequence to SEQ ID NO:1.

In some embodiments, the antibody comprises a V_(L) domain that is atleast 85%, at least 86%, at least 87%, at least 88%, at least 89%, atleast 90%, at least 91%, at least 92%, at least 93%, at least 94%, atleast 95%, at least 96%, at least 97% at least 98%, at least 99% or 100%identical in amino acid sequence to SEQ ID NO:2.

In some embodiments, the antibody comprises a heavy chain sequence thatis at least 85%, at least 86%, at least 87%, at least 88%, at least 89%,at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, atleast 95%, at least 96%, at least 97% at least 98%, at least 99% or 100%identical in amino acid sequence to SEQ ID NO:11.

In some embodiments, the antibody comprises a light chain sequence thatis at least 85%, at least 86%, at least 87%, at least 88%, at least 89%,at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, atleast 95%, at least 96%, at least 97% at least 98%, at least 99% or 100%identical in amino acid sequence to SEQ ID NO:12.

In some embodiments, the antibody comprises a fragment or a region ofthe antibody G1 or its variants shown in Table 6. In one embodiment, thefragment is a light chain of the antibody G1. In another embodiment, thefragment is a heavy chain of the antibody G1. In yet another embodiment,the fragment contains one or more variable regions from a light chainand/or a heavy chain of the antibody G1. In yet another embodiment, thefragment contains one or more variable regions from a light chain and/ora heavy chain shown in FIG. 5. In yet another embodiment, the fragmentcontains one or more CDRs from a light chain and/or a heavy chain of theantibody G1.

In some embodiments, the polypeptide (such as an antibody) comprises theamino acid sequence of KASKXaaVXaaTYVS (SEQ ID NO:53), wherein Xaa atposition 5 is R, W, G, L, or N; and wherein Xaa at position 7 is T, A,D, G, R, S, W, or V. In some embodiments, the amino acid sequence ofKASKXaaVXaaTYVS (SEQ ID NO:53) is CDR1 of an antibody light chain.

In some embodiments, the polypeptide (such as an antibody) comprises theamino acid sequence of XaaXaaSNRYXaa (SEQ ID NO:54), wherein Xaa atposition 1 is G or A; wherein Xaa at position 2 is A or H; and whereinXaa at position 7 is L, T, I, or S. In some embodiments, the amino acidsequence of XaaXaaSNRYXaa (SEQ ID NO:54) is CDR2 of an antibody lightchain.

In some embodiments, the polypeptide (such as an antibody) comprises theamino acid sequence of EIRSXaaSDXaaXaaATXaaYAXaaAVKG (SEQ ID NO:55),wherein Xaa at position 5 is E, R, K, Q, or N; wherein Xaa at position 8is A, G, N, E, H, S, L, R, C, F, Y, V, D, or P; wherein Xaa at position9 is S, G, T, Y, C, E, L, A, P, I, N, R, V, D, or M; wherein Xaa atposition 12 is H or F; wherein Xaa at position 15 is E or D. In someembodiments, the amino acid sequence of EIRSXaaSDXaaXaaATXaaYAXaaAVKG(SEQ ID NO:55) is CDR2 of an antibody heavy chain.

In some embodiments, the antibody is a human antibody. In otherembodiments, the antibody a humanized antibody. In some embodiments, theantibody is monoclonal. In some embodiments, the antibody (orpolypeptide) is isolated. In some embodiments, the antibody (orpolypeptide) is substantially pure.

The heavy chain constant region of the antibodies may be from any typesof constant region, such as IgG, IgM, IgD, IgA, and IgE; and anyisotypes, such as IgG1, IgG2, IgG3, and IgG4.

In some embodiments, the antibody comprises a modified constant regionas described herein.

In one aspect, the invention provides a composition for use indecreasing a number of monthly headache hours experienced by a subjectwith refractory migraine. In one embodiment, the use comprisesadministering to the subject an amount of a monoclonal antibody thatmodulates the CGRP pathway, wherein the monoclonal antibody is in anamount effective to decrease the number of monthly headache hours by atleast 20 (e.g., 25, 30, 35, 40, 45, 50, 55, 60, 65, 70 or more headachehours) after a single dose. In some embodiments, the number of monthlyheadache hours is reduced by at least about 50 hours. In one embodiment,the use comprises administering to the subject an amount of a monoclonalantibody that modulates the CGRP pathway, wherein the monoclonalantibody is in an amount effective to decrease the number of monthlyheadache hours by at least 15% (e.g., 20%, 25%, 30%, 35%, 40%, or more)after a single dose. In some embodiments, the number of monthly headachehours is reduced by at least about 30%. In some embodiments, themonoclonal antibody is an anti-CGRP antagonist antibody. In someembodiments, the amount of the monoclonal antibody administered to thepatient is about 675 mg to about 1000 mg. In some embodiments, themonoclonal antibody is administered monthly. In some embodiments, themonoclonal antibody is administered as a single dose. In someembodiments, the administering is subcutaneous or intravenousadministration. In some embodiments, the monoclonal antibody isformulated at a concentration of at least 150 mg/m L. In someembodiments, wherein the monoclonal antibody is administered in a volumeof less than 2 mL. In some embodiments, the subject is human. In someembodiments, the monoclonal antibody is human or humanized. In someembodiments, the monoclonal antibody comprises (a) an antibody having aCDR H1 as set forth in SEQ ID NO:3; a CDR H2 as set forth in SEQ IDNO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 as set forth in SEQID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and a CDR L3 as set forthin SEQ ID NO:8; or (b) a variant of an antibody according to (a) asshown in Table 6.

In one aspect, the invention provides a composition for use indecreasing a number of monthly headache days experienced by a subjectwith refractory migraine. In one embodiment, the use comprisesadministering to the subject an amount of a monoclonal antibody thatmodulates the CGRP pathway, wherein the monoclonal antibody is in anamount effective to decrease the number of monthly headache days by atleast 3 (e.g., 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18,19, 20 or more headache days) after a single dose. In some embodiments,the number of monthly headache days is reduced by at least about 6headache days. In some embodiments, the monoclonal antibody is ananti-CGRP antagonist antibody. In some embodiments, the amount of themonoclonal antibody administered to the patient is about 675 mg to about1000 mg. In some embodiments, the monoclonal antibody is administeredmonthly. In some embodiments, the monoclonal antibody is administered asa single dose. In some embodiments, the administering is subcutaneous orintravenous administration. In some embodiments, the monoclonal antibodyis formulated at a concentration of at least 150 mg/mL. In someembodiments, wherein the monoclonal antibody is administered in a volumeof less than 2 mL, e.g., about 1.5 mL. In some embodiments, the subjectis human. In some embodiments, the monoclonal antibody is human orhumanized. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6.

In one aspect, the invention provides a composition for use indecreasing use of any acute headache medication in a subject withrefractory migraine, comprising administering to the subject amonoclonal antibody (e.g., anti-CGRP antagonist antibody) that modulatesthe CGRP pathway, wherein the monoclonal antibody is in an amounteffective to decrease monthly use of the acute headache medication bythe subject by at least 15% (e.g., 20%, 25%, 30%, 35%, 40%, or more). Insome embodiments, the headache medication is selected from the groupconsisting of 5-HT1 agonists, triptans, opiates, ergot alkaloids, andnon-steroidal anti-inflammatory drugs (NSAIDs). In some embodiments, theheadache medication is a triptan or ergot compound. In some embodiments,the acute headache medication is selected from the group consisting ofanalgesics (e.g., acetylsalicylic acid, ibuprofen, naproxen, diclofenac,paracetamol, acetylsalicylic acid plus paracetamol plus caffeine,metamizol, phenazon, or tolfenamic acid); antiemetics (e.g.,metoclopramide or domperidon); ergot alkaloids (e.g., ergotaminetartrate or dihydroergotamine); and triptans, i.e., 5-HT1 agonists(e.g., sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan,eletriptan, or frovatriptan). In some embodiments, the amount of themonoclonal antibody administered to the patient is about 675 mg to about1000 mg. In some embodiments, the monoclonal antibody is administeredmonthly. In some embodiments, the monoclonal antibody is administered asa single dose. In some embodiments, the administering is subcutaneous orintravenous administration. In some embodiments, the monoclonal antibodyis formulated at a concentration of at least 150 mg/mL. In someembodiments, wherein the monoclonal antibody is administered in a volumeof less than 2 mL, e.g., about 1.5 mL. In some embodiments, the subjectis human. In some embodiments, the monoclonal antibody is human orhumanized. In some embodiments, the monoclonal antibody comprises (a) anantibody having a CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as setforth in SEQ ID NO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 asset forth in SEQ ID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and aCDR L3 as set forth in SEQ ID NO:8; or (b) a variant of an antibodyaccording to (a) as shown in Table 6. In one aspect, the inventionprovides a composition for use in of preventing, treating, or reducingincidence of migraine in a subject having refractory migraine comprisingadministering to the subject a single dose of a monoclonal antibody(e.g., monoclonal anti-CGRP-antagonist antibody) in an amount thatmodulates the CGRP pathway, wherein the amount of the monoclonalantibody administered to the patient is about 675 mg to about 1000 mg.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a table showing binding affinities of 12 murine antibodies fordifferent alanine substituted human α-CGRP fragments. Binding affinitieswere measured at 25° C. using Biacore by flowing Fabs across CGRPs onthe chip. The boxed values represent the loss in affinity of alaninemutants relative to parental fragment, 25-37 (italic), except K35A,which was derived from a 19-37 parent. “^(a)” indicates affinities for19-37 and 25-37 fragments are the mean average±standard deviation of twoindependent measurements on different sensor chips. “^(b)” indicatesthese interactions deviated from a simple bimolecular interaction modeldue to a biphasic offrate, so their affinities were determined using aconformational change model. Grey-scale key: white (1.0) indicatesparental affinity; light grey (less than 0.5) indicates higher affinitythan parent; dark grey (more than 2) indicates lower affinity thanparent; and black indicates that no binding was detected.

FIGS. 2A and 2B show the effect of administering CGRP 8-37 (400nmol/kg), antibody 4901 (25 mg/kg), and antibody 7D11 (25 mg/kg) on skinblood flow measured as blood cell flux after electrical pulsestimulation for 30 seconds. CGRP 8-37 was administered intravenously(iv) 3-5 min before electrical pulse stimulation. Antibodies wereadministered intraperitoneal (IP) 72 hours before electrical pulsestimulation. Each point in the graphs represents AUC of one rat treatedunder the conditions as indicated. Each line in the graphs representsaverage AUC of rats treated under the condition as indicated. AUC (areaunder the curve) equals to Δflux×Δtime. “Δflux” represents the change offlux units after the electrical pulse stimulation; and “Δtime”represents the time period taken for the blood cell flux level to returnto the level before the electrical pulse stimulation.

FIG. 3 shows the effect of administering different dosage of antibody4901 (25 mg/kg, 5 mg/kg, 2.5 mg/kg, or 1 mg/kg) on skin blood flowmeasured as blood cell flux after electrical pulse stimulation for 30seconds. Antibodies were administered intravenously (IV) 24 hours beforeelectrical pulse stimulation. Each point in the graph represents AUC ofone rat treated under the conditions as indicated. The line in the graphrepresents average AUC of rats treated under the condition as indicated.

FIGS. 4A and 4B show the effect of administering antibody 4901 (1 mg/kgor 10 mg/kg, i.v.), antibody 7E9 (10 mg/kg, i.v.), and antibody 8B6 (10mg/kg, i.v.) on skin blood flow measured as blood cell flux afterelectrical pulse stimulation for 30 seconds. Antibodies wereadministered intravenously (i.v.) followed by electrical pulsestimulation at 30 min, 60 min, 90 min, and 120 min after antibodyadministration. Y axis represents percent of AUC as compared to level ofAUC when no antibody was administered (time 0). X axis represents time(minutes) period between the administration of antibodies and electricalpulse stimulation. “*” indicates P<0.05, and “**” indicates P<0.01, ascompared to time 0. Data were analyzed using one-way ANOVA with aDunnett's Multiple comparison test.

FIG. 5 shows the amino acid sequence of the heavy chain variable region(SEQ ID NO:1) and light chain variable region (SEQ ID NO:2) of antibodyG1. The Kabat CDRs are in bold text, and the Chothia CDRs areunderlined. The amino acid residues for the heavy chain and light chainvariable region are numbered sequentially.

FIG. 6 shows epitope mapping of antibody G1 by peptide competition usingBiacore. N-biotinylated human α-CGRP was captured on SA sensor chip. G1Fab (50 nM) in the absence of a competing peptide or pre-incubated for 1hour with 10 μM of a competing peptide was flowed onto the chip. Bindingof G1 Fab to the human α-CGRP on the chip was measured. Y axisrepresents percentage of binding blocked by the presence of thecompeting peptide compared with the binding in the absence of thecompeting peptide.

DETAILED DESCRIPTION

In some aspects, the invention disclosed herein provides methods forpreventing, treating, and/or reducing incidence of migraine in an in asubject having refractory migraine by administering to the individual atherapeutically effective amount of an anti-CGRP antagonist antibody.

In some aspects, the invention disclosed herein also provides anti-CGRPantagonist antibodies and polypeptides derived from G1 or its variantsshown in Table 6, or compositions thereof, for use in treating and/orreducing incidence of migraine in a subject having refractory migraine.

General Techniques

The practice of the various aspects of the present invention willemploy, unless otherwise indicated, conventional techniques of molecularbiology (including recombinant techniques), microbiology, cell biology,biochemistry and immunology, which are within the skill of the art. Suchtechniques are explained fully in the literature, such as, MolecularCloning: A Laboratory Manual, second edition (Sambrook et al., 1989)Cold Spring Harbor Press; Oligonucleotide Synthesis (M. J. Gait, ed.,1984); Methods in Molecular Biology, Humana Press; Cell Biology: ALaboratory Notebook (J. E. Cellis, ed., 1998) Academic Press; AnimalCell Culture (R. I. Freshney, ed., 1987); Introduction to Cell andTissue Culture (J. P. Mather and P. E. Roberts, 1998) Plenum Press; Celland Tissue Culture: Laboratory Procedures (A. Doyle, J. B. Griffiths,and D. G. Newell, eds., 1993-1998) J. Wiley and Sons; Methods inEnzymology (Academic Press, Inc.); Handbook of Experimental Immunology(D. M. Weir and C. C. Blackwell, eds.); Gene Transfer Vectors forMammalian Cells (J. M. Miller and M. P. Calos, eds., 1987); CurrentProtocols in Molecular Biology (F. M. Ausubel et al., eds., 1987); PCR:The Polymerase Chain Reaction, (Mullis et al., eds., 1994); CurrentProtocols in Immunology (J. E. Coligan et al., eds., 1991); ShortProtocols in Molecular Biology (Wiley and Sons, 1999); Immunobiology (C.A. Janeway and P. Travers, 1997); Antibodies (P. Finch, 1997);Antibodies: a practical approach (D. Catty., ed., IRL Press, 1988-1989);Monoclonal antibodies: a practical approach (P. Shepherd and C. Dean,eds., Oxford University Press, 2000); Using antibodies: a laboratorymanual (E. Harlow and D. Lane (Cold Spring Harbor Laboratory Press,1999); The Antibodies (M. Zanetti and J. D. Capra, eds., HarwoodAcademic Publishers, 1995).

Definitions

As used herein, “about” when used in reference to numerical ranges,cutoffs, or specific values is used to indicate that the recited valuesmay vary by up to as much as 10% from the listed value. Thus, the term“about” is used to encompass variations of ±10% or less, variations of±5% or less, variations of ±1% or less, variations of ±0.5% or less, orvariations of ±0.1% or less from the specified value.

An “antibody” is an immunoglobulin molecule capable of specific bindingto a target, such as a carbohydrate, polynucleotide, lipid, polypeptide,etc., through at least one antigen recognition site, located in thevariable region of the immunoglobulin molecule. As used herein, the termencompasses not only intact polyclonal or monoclonal antibodies, butalso fragments thereof (such as Fab, Fab′, F(ab′)₂, Fv), single chain(ScFv), mutants thereof, fusion proteins comprising an antibody portion(such as domain antibodies), and any other modified configuration of theimmunoglobulin molecule that comprises an antigen recognition site. Anantibody includes an antibody of any class, such as IgG, IgA, or IgM (orsub-class thereof), and the antibody need not be of any particularclass. Depending on the antibody amino acid sequence of the constantdomain of its heavy chains, immunoglobulins can be assigned to differentclasses. There are five major classes of immunoglobulins: IgA, IgD, IgE,IgG, and IgM, and several of these may be further divided intosubclasses (isotypes), e.g., IgG1, IgG2, IgG3, IgG4, IgA1, and IgA2. Theheavy-chain constant domains that correspond to the different classes ofimmunoglobulins are called alpha, delta, epsilon, gamma, and mu,respectively. The subunit structures and three-dimensionalconfigurations of different classes of immunoglobulins are well known.

As used herein, “monoclonal antibody” refers to an antibody obtainedfrom a population of substantially homogeneous antibodies, i.e., theindividual antibodies comprising the population are identical except forpossible naturally-occurring mutations that may be present in minoramounts. Monoclonal antibodies are highly specific, being directedagainst a single antigenic site. Furthermore, in contrast to polyclonalantibody preparations, which typically include different antibodiesdirected against different determinants (epitopes), each monoclonalantibody is directed against a single determinant on the antigen. Themodifier “monoclonal” indicates the character of the antibody as beingobtained from a substantially homogeneous population of antibodies, andis not to be construed as requiring production of the antibody by anyparticular method. For example, the monoclonal antibodies to be used inaccordance with the present invention may be made by the hybridomamethod first described by Kohler and Milstein, 1975, Nature, 256:495, ormay be made by recombinant DNA methods such as described in U.S. Pat.No. 4,816,567. The monoclonal antibodies may also be isolated from phagelibraries generated using the techniques described in McCafferty et al.,1990, Nature, 348:552-554, for example.

As used herein, “humanized” antibodies refer to forms of non-human(e.g., murine) antibodies that are specific chimeric immunoglobulins,immunoglobulin chains, or fragments thereof (such as Fv, Fab, Fab′,F(ab′)₂ or other antigen-binding subsequences of antibodies) thatcontain minimal sequence derived from non-human immunoglobulin. For themost part, humanized antibodies are human immunoglobulins (recipientantibody) in which residues from a complementarity determining region(CDR) of the recipient are replaced by residues from a CDR of anon-human species (donor antibody) such as mouse, rat, or rabbit havingthe desired specificity, affinity, and, biological activity. In someinstances, Fv framework region (FR) residues of the human immunoglobulinare replaced by corresponding non-human residues. Furthermore, thehumanized antibody may comprise residues that are found neither in therecipient antibody nor in the imported CDR or framework sequences, butare included to further refine and optimize antibody performance. Ingeneral, the humanized antibody will comprise substantially all of atleast one, and typically two, variable domains, in which all orsubstantially all of the CDR regions correspond to those of a non-humanimmunoglobulin and all or substantially all of the FR regions are thoseof a human immunoglobulin consensus sequence. The humanized antibodyoptimally also will comprise at least a portion of an immunoglobulinconstant region or domain (Fc), typically that of a humanimmunoglobulin. Antibodies may have Fc regions modified as described inWO 99/58572. Other forms of humanized antibodies have one or more CDRs(one, two, three, four, five, six) which are altered with respect to theoriginal antibody, which are also termed one or more CDRs “derived from”one or more CDRs from the original antibody.

As used herein, “human antibody” means an antibody having an amino acidsequence corresponding to that of an antibody produced by a human and/orhas been made using any of the techniques for making human antibodiesknown in the art or disclosed herein. This definition of a humanantibody includes antibodies comprising at least one human heavy chainpolypeptide or at least one human light chain polypeptide. One suchexample is an antibody comprising murine light chain and human heavychain polypeptides. Human antibodies can be produced using varioustechniques known in the art. In one embodiment, the human antibody isselected from a phage library, where that phage library expresses humanantibodies (Vaughan et al., 1996, Nature Biotechnology, 14:309-314;Sheets et al., 1998, PNAS, (USA) 95:6157-6162; Hoogenboom and Winter,1991, J. Mol. Biol., 227:381; Marks et al., 1991, J. Mol. Biol.,222:581). Human antibodies can also be made by introducing humanimmunoglobulin loci into transgenic animals, e.g., mice in which theendogenous immunoglobulin genes have been partially or completelyinactivated. This approach is described in U.S. Pat. Nos. 5,545,807;5,545,806; 5,569,825; 5,625,126; 5,633,425; and 5,661,016.Alternatively, the human antibody may be prepared by immortalizing humanB lymphocytes that produce an antibody directed against a target antigen(such B lymphocytes may be recovered from an individual or may have beenimmunized in vitro). See, e.g., Cole et al., Monoclonal Antibodies andCancer Therapy, Alan R. Liss, p. 77 (1985); Boerner et al., 1991, J.Immunol., 147 (1):86-95; and U.S. Pat. No. 5,750,373.

As used herein, the term “calcitonin gene-related peptide” and “CGRP”refers to any form of calcitonin gene-related peptide and variantsthereof that retain at least part of the activity of CGRP. For example,CGRP may be α-CGRP or β-CGRP. As used herein, CGRP includes allmammalian species of native sequence CGRP, e.g., human, canine, feline,equine, and bovine.

As used herein, an “anti-CGRP antagonist antibody” (interchangeablytermed “anti-CGRP antibody”) refers to an antibody that is able to bindto CGRP and inhibit CGRP biological activity and/or downstreampathway(s) mediated by CGRP signaling. An anti-CGRP antagonist antibodyencompasses antibodies that modulate, block, antagonize, suppress orreduce (including significantly) CGRP biological activity, or otherwiseantagonize the CGRP pathway, including downstream pathways mediated byCGRP signaling, such as receptor binding and/or elicitation of acellular response to CGRP. For purpose of the present invention, it willbe explicitly understood that the term “anti-CGRP antagonist antibody”encompasses all the previously identified terms, titles, and functionalstates and characteristics whereby CGRP itself, CGRP biological activity(including but not limited to its ability to mediate any aspect ofheadache), or the consequences of the biological activity, aresubstantially nullified, decreased, or neutralized in any meaningfuldegree. In some embodiments, an anti-CGRP antagonist antibody binds CGRPand prevents CGRP binding to a CGRP receptor. In other embodiments, ananti-CGRP antibody binds CGRP and prevents activation of a CGRPreceptor. Examples of anti-CGRP antagonist antibodies are providedherein.

As used herein, the terms “G1,” “antibody G1,” “TEV-48125,” andfremanezumab are used interchangeably to refer to an anti-CGRPantagonist antibody produced by expression vectors having depositnumbers of ATCC PTA-6867 and ATCC PTA-6866. The amino acid sequence ofthe heavy chain and light chain variable regions are shown in FIG. 5.The CDR portions of antibody G1 (including Chothia and Kabat CDRs) arediagrammatically depicted in FIG. 5. The polynucleotides encoding theheavy and light chain variable regions are shown in SEQ ID NO:9 and SEQID NO:10. The G1 heavy chain full antibody amino acid sequence is shownin SEQ ID NO:11. The G1 light chain full antibody amino acid sequence isshown in SEQ ID NO:12. The characterization and processes for makingantibody G1 (and variants thereof) are described in Examples 1-4 infra,as well as PCT Application No. PCT/IB2006/003181, which is herebyincorporated by reference in its entirety

The terms “polypeptide”, “oligopeptide”, “peptide” and “protein” areused interchangeably herein to refer to polymers of amino acids of anylength. The polymer may be linear or branched, it may comprise modifiedamino acids, and it may be interrupted by non-amino acids. The termsalso encompass an amino acid polymer that has been modified naturally orby intervention; for example, disulfide bond formation, glycosylation,lipidation, acetylation, phosphorylation, or any other manipulation ormodification, such as conjugation with a labeling component. Alsoincluded within the definition are, for example, polypeptides containingone or more analogs of an amino acid (including, for example, unnaturalamino acids, etc.), as well as other modifications known in the art. Itis understood that, because the polypeptides of this invention are basedupon an antibody, the polypeptides can occur as single chains orassociated chains.

“Polynucleotide,” or “nucleic acid,” as used interchangeably herein,refer to polymers of nucleotides of any length, and include DNA and RNA.The nucleotides can be deoxyribonucleotides, ribonucleotides, modifiednucleotides or bases, and/or their analogs, or any substrate that can beincorporated into a polymer by DNA or RNA polymerase. A polynucleotidemay comprise modified nucleotides, such as methylated nucleotides andtheir analogs. If present, modification to the nucleotide structure maybe imparted before or after assembly of the polymer. The sequence ofnucleotides may be interrupted by non-nucleotide components. Apolynucleotide may be further modified after polymerization, such as byconjugation with a labeling component. Other types of modificationsinclude, for example, “caps”, substitution of one or more of thenaturally occurring nucleotides with an analog, internucleotidemodifications such as, for example, those with uncharged linkages (e.g.,methyl phosphonates, phosphotriesters, phosphoamidates, carbamates,etc.) and with charged linkages (e.g., phosphorothioates,phosphorodithioates, etc.), those containing pendant moieties, such as,for example, proteins (e.g., nucleases, toxins, antibodies, signalpeptides, ply-L-lysine, etc.), those with intercalators (e.g., acridine,psoralen, etc.), those containing chelators (e.g., metals, radioactivemetals, boron, oxidative metals, etc.), those containing alkylators,those with modified linkages (e.g., alpha anomeric nucleic acids, etc.),as well as unmodified forms of the polynucleotide(s). Further, any ofthe hydroxyl groups ordinarily present in the sugars may be replaced,for example, by phosphonate groups, phosphate groups, protected bystandard protecting groups, or activated to prepare additional linkagesto additional nucleotides, or may be conjugated to solid supports. The5′ and 3′ terminal OH can be phosphorylated or substituted with aminesor organic capping group moieties of from 1 to 20 carbon atoms. Otherhydroxyls may also be derivatized to standard protecting groups.Polynucleotides can also contain analogous forms of ribose ordeoxyribose sugars that are generally known in the art, including, forexample, 2′-O-methyl-, 2′-O-allyl, 2′-fluoro- or 2′-azido-ribose,carbocyclic sugar analogs, α-anomeric sugars, epimeric sugars such asarabinose, xyloses or lyxoses, pyranose sugars, furanose sugars,sedoheptuloses, acyclic analogs and abasic nucleoside analogs such asmethyl riboside. One or more phosphodiester linkages may be replaced byalternative linking groups. These alternative linking groups include,but are not limited to, embodiments wherein phosphate is replaced byP(O)S (“thioate”), P(S)S (“dithioate”), (O)NR₂ (“amidate”), P(O)R,P(O)OR′, CO or CH₂ (“formacetal”), in which each R or R′ isindependently H or substituted or unsubstituted alkyl (1-20 C)optionally containing an ether (—O—) linkage, aryl, alkenyl, cycloalkyl,cycloalkenyl or araldyl. Not all linkages in a polynucleotide need beidentical. The preceding description applies to all polynucleotidesreferred to herein, including RNA and DNA.

As used herein, refractory migraine patients (or “subject havingrefractory migraine”) are considered refractory if they have adocumented inadequate response (in a medical chart or by treatingphysician's confirmation) to at least two preventive medications (from adifferent cluster, defined below). Refractory migraine patients can alsobe considered refractory if they have a documented inadequate response(in a medical chart or by treating physician's confirmation) to two tofour classes of prior preventive medications (from different cluster, asdefined below), e.g., inadequate response to two classes of priorpreventive mendications, inadequate response to three classes of priorpreventative medications, or an inadequate response to four classes ofprior preventative medications.

Inadequate response is defined as: no clinically meaningful improvementper treating physician's judgement, after at least three months oftherapy at a stable dose considered appropriate for migraine preventionaccording to accepted country guidelines, or when treatment has to beinterrupted because of adverse events that made it intolerable by thepatient or the drug is contraindicated or not suitable for the patient.The three-month period may not apply if the drug is intolerable orcontraindicated or not suitable for the patient. For onabotulinumtoxinA,an inadequate response is defined as: no clinically meaningfulimprovement per treating physician's judgement, after at least sixmonths of therapy at a stable dose considered appropriate for migraineprevention according to accepted country guidelines, or when treatmenthas to be interrupted because of adverse events that made it intolerableby the patient. Or, if onabotulinumtoxinA is a previous preventativemedication, at least two sets of injections and three months should havepassed since the last set of injections.

In some embodiments, the clusters are as follows:

-   -   cluster A: topiramate, carbamazepine, divalproex sodium, and        sodium valproate    -   cluster B: flunarizine and pizotifen    -   cluster C: amitriptyline, venlafaxine, nortriptyline, and        duloxetine    -   cluster D: atenolol, nadolol, metoprolol, propranolol, and        timolol    -   cluster E: onabotulinumtoxinA

In some embodiments, the clusters are as follows:

-   -   cluster A: beta-blockers: propranolol, metoprolol, atenolol, and        bisopropol    -   cluster B: anticonvulsants: topiramate    -   cluster C: tricyclics: amitriptyline    -   cluster D: calcium channel blocker: flunarizine    -   cluster E: angiotensin II receptor antagonist: candesartan    -   cluster F: onabotulinumtoxinA    -   cluster G: valproic acid

Within this group of clusters, a subject has refractory migraine if thepatient has an inadequate response to two to four classes ofpreventative headache medications. For example, a subject has refractorymigraine if the patient has an inadequate response to two or threemedications each from different clusters (A, B, C, D, E, F) and valproicacid (cluster G).

Additional clusters include:

-   -   cluster a: an angiotensin-converting enzyme (ACE) inhibitor,        such as lisinopril,    -   cluster b: a benzocycloheptene-based drug, such as pizotifen    -   cluster c: an antidepressant, such as amitriptyline (Elavil),        trazodone (Desyrel), and imipramine (Tofranil), and venlafaxine    -   cluster d: an anticonvulsant such as phenytoin (Dilantin) or        carbamazepine (Tegretol)    -   cluster e: oxeterone

A skilled practitioner will be readily able to recognize and/or diagnosea subject with a refractory migraine.

As used herein, “preventing” is an approach to stop migraine fromoccurring or existing in a subject, who is not already experiencingmigraine. As used herein, “treatment” is an approach for obtainingbeneficial or desired clinical results. For purposes of this invention,beneficial or desired clinical results include, but are not limited to,one or more of the following: improvement in any aspect of a refractorymigraine, including lessening severity, alleviation of pain intensity,and other associated symptoms, reducing frequency of recurrence,reducing the muber of monthly headache days or hours, increasing thequality of life of those suffering from refractory migraine, anddecreasing dose of other medications (e.g., acute headache medication)required to treat the refractory migraine.

“Reducing incidence” of migraine means any of reducing severity (whichcan include reducing need for and/or amount of (e.g., exposure to) otherdrugs and/or therapies generally used for this condition, including, forexample, ergotamine, dihydroergotamine, or triptans), duration, and/orfrequency (including, for example, delaying or increasing time to nextepisodic attack in an individual). As is understood by those skilled inthe art, individuals may vary in terms of their response to treatment,and, as such, for example, a “method of reducing incidence of migrainein an individual” reflects administering the anti-CGRP antagonistantibody based on a reasonable expectation that such administration maylikely cause such a reduction in incidence of migraine in thatparticular individual.

“Ameliorating” migraine or one or more symptoms of refractory migrainemeans a lessening or improvement of one or more symptoms of migraine ina subject having refractory migraine as compared to not administering ananti-CGRP antagonist antibody. “Ameliorating” also includes shorteningor reduction in duration of a symptom.

As used herein, “controlling refractory migraine” refers to maintainingor reducing severity or duration of one or more symptoms of migraine,e.g., the frequency of migraine attacks in an individual havingrefractory migraine (as compared to the level before treatment). Forexample, the duration or severity of head pain, or frequency of attacksis reduced by at least about any of 10%, 20%, 30%, 40%, 50%, 60%, or 70%in the individual as compared to the level before treatment.

As used herein, a “headache hour” refers to an hour during which asubject experiences headache. Headache hours can be expressed in termsof whole hours (e.g., one headache hour, two headache hours, threeheadache hours, etc.) or in terms of whole and partial hours (e.g., 0.5headache hours, 1.2 headache hours, 2.67 headache hours, etc.). One ormore headache hours may be described with respect to a particular timeinterval. For example, “daily headache hours” may refer to the number ofheadache hours a subject experiences within a day interval (e.g., a24-hour period). In another example, “weekly headache hours” may referto the number of headache hours a subject experiences within a weekinterval (e.g., a 7-day period). As can be appreciated, a week intervalmay or may not correspond to a calendar week. In another example,“monthly headache hours” may refer to the number of headache hours asubject experiences within a month interval. As can be appreciated, amonth interval (e.g., a period of 28, 29, 30, or 31 days) may vary interms of number of days depending upon the particular month and may ormay not correspond to a calendar month. In yet another example, “yearlyheadache hours” may refer to the number of headache hours a subjectexperiences within a year interval. As can be appreciated, a yearinterval (e.g., a period of 365 or 366 days) may vary in terms of numberof days depending upon the particular year and may or may not correspondto a calendar year.

As used herein, a “headache day” refers to a day during which a subjectexperiences headache. Headache days can be expressed in terms of wholedays (e.g., one headache day, two headache days, three headache days,etc.) or in terms of whole and partial days (e.g., 0.5 headache days,1.2 headache days, 2.67 headache days, etc.). One or more headache daysmay be described with respect to a particular time interval. Forexample, “weekly headache days” may refer to the number of headache daysa subject experiences within a week interval (e.g., a 7-day period). Ascan be appreciated, a week interval may or may not correspond to acalendar week. In another example, “monthly headache days” may refer tothe number of headache days a subject experiences within a monthinterval. As can be appreciated, a month interval (e.g., a period of 28,29, 30, or 31 days) may vary in terms of number of days depending uponthe particular month and may or may not correspond to a calendar month.In yet another example, “yearly headache days” may refer to the numberof headache days a subject experiences within a year interval. As can beappreciated, a year interval (e.g., a period of 365 or 366 days) mayvary in terms of number of days depending upon the particular year andmay or may not correspond to a calendar year.

As used therein, “delaying” the development of migraine means to defer,hinder, slow, retard, stabilize, and/or postpone progression of thedisease in a subject having refractory migraine. This delay can be ofvarying lengths of time, depending on the history of the disease and/orindividuals being treated. As is evident to one skilled in the art, asufficient or significant delay can, in effect, encompass prevention, inthat the individual does not develop migraine, especially after beingdiagnosed with refractory migraine due to inadequate response to priorpreventative treatments. A method that “delays” development of thesymptom is a method that reduces probability of developing the symptomin a given time frame and/or reduces extent of the symptoms in a giventime frame, when compared to not using the method. Such comparisons aretypically based on clinical studies, using a statistically significantnumber of subjects.

“Development” or “progression” of migraine means initial manifestationsand/or ensuing progression of the disorder in a subject havingrefractory migraine. Development of migraine can be detectable andassessed using standard clinical techniques as well known in the art.

As used herein, an “effective dosage” or “effective amount” of drug,compound, or pharmaceutical composition is an amount sufficient toeffect beneficial or desired results. For prophylactic use, beneficialor desired results include results such as eliminating or reducing therisk, lessening the severity, or delaying the onset of the disease,including biochemical, histological and/or behavioral symptoms of thedisease, its complications and intermediate pathological phenotypespresenting during development of the disease. For therapeutic use,beneficial or desired results include clinical results such as reducingpain intensity, duration, or frequency of refractory migraine attack,and decreasing one or more symptoms resulting from refractory migraine(biochemical, histological and/or behavioral), including itscomplications and intermediate pathological phenotypes presenting duringdevelopment of the disease, increasing the quality of life of thosesuffering from the disease, decreasing the dose of other medicationsrequired to treat the disease, enhancing effect of another medication,and/or delaying the progression of the disease of patients. An effectivedosage can be administered in one or more administrations. For purposesof this disclosure, an effective dosage of drug, compound, orpharmaceutical composition is an amount sufficient to accomplishprophylactic or therapeutic treatment either directly or indirectly. Asis understood in the clinical context, an effective dosage of a drug,compound, or pharmaceutical composition may or may not be achieved inconjunction with another drug, compound, or pharmaceutical composition.Thus, an “effective dosage” may be considered in the context ofadministering one or more therapeutic agents, and a single agent may beconsidered to be given in an effective amount if, in conjunction withone or more other agents, a desirable result may be or is achieved.

An “individual” or a “subject” is a mammal, more preferably a human.Mammals also include, but are not limited to, farm animals, sportanimals, pets, primates, horses, dogs, cats, mice and rats.

A. Methods for Preventing, Treating, or Reducing Refractory Migraineand/or at Least One Secondary Symptom Associated with RefractoryMigraine

In one aspect, the invention provides methods of preventing, treating,or reducing incidence of migraine in a subject having refractorymigraine. In another aspect, the invention provides a method of treatingor reducing incidence of at least one secondary symptom associated withrefractory migraine in a subject. In some embodiments, the methodcomprises administering to the individual an effective amount of anantibody or polypeptides derived from the antibody that modulates theCGRP pathway (e.g., a monoclonal anti-CGRP antagonist antibody).

In another aspect, the invention provides methods for preventing,ameliorating, controlling, reducing incidence of, or delaying theprogression of migraine in an individual having refractory migraine orsymptoms associated with the diagnosis of refractory migraine comprisingadministering to the individual an effective amount of an antibody thatmodulates the CGRP pathway or an anti-CGRP antagonist antibody incombination with additional agent(s) useful for treating migraine, forexample, the additional agent(s) can be an acute headache medication.

Such additional agents include, but are not limited to, 5-HT agonists,triptans, NSAIDs, analgesics, antiemetics, ergot alkaloids. For example,the antibody and the at least one additional acute migrainte medicationcan be concomitantly administered, i.e., they can be given in closeenough temporal proximity to allow their individual therapeutic effectsto overlap.

Additional non-limiting examples of additional acute migraine agentsthat may be administered in combination with an anti-CGRP antagonistantibody include one or more of:

(i) an opioid analgesic, e.g., morphine, heroin, hydromorphone,oxymorphone, levorphanol, levallorphan, methadone, meperidine, fentanyl,cocaine, codeine, dihydrocodeine, oxycodone, hydrocodone, propoxyphene,nalmefene, nalorphine, naloxone, naltrexone, buprenorphine, butorphanol,nalbuphine or pentazocine;(ii) a nonsteroidal antiinflammatory drug (NSAID), e.g., aspirin,diclofenac, diflusinal, etodolac, fenbufen, fenoprofen, flufenisal,flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac,meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxaprozin,phenylbutazone, piroxicam, sulindac, tolmetin or zomepirac,cyclooxygenase-2 (COX-2) inhibitors, celecoxib; rofecoxib; meloxicam;JTE-522; L-745,337; NS398; or a pharmaceutically acceptable saltthereof;(iii) a barbiturate sedative, e.g., amobarbital, aprobarbital,butabarbital, butabital (including butalbital combinations, e.g.,butalbital/aspirin/caffeine (Fiorinal®, Actavis) orbutalbital/paracetamol/caffeine (Fioricet®, Cardinal Health)),mephobarbital, metharbital, methohexital, pentobarbital, phenobartital,secobarbital, talbutal, theamylal or thiopental; or a pharmaceuticallyacceptable salt thereof;(iv) a barbiturate analgesic, e.g., butalbital or a pharmaceuticallyacceptable salt thereof or a composition comprising butalbital.(v) a benzodiazepine having a sedative action, e.g., chlordiazepoxide,clorazepate, diazepam, flurazepam, lorazepam, oxazepam, temazepam, ortriazolam or a pharmaceutically acceptable salt thereof;(vi) an H1 antagonist having a sedative action, e.g., diphenhydramine,pyrilamine, promethazine, chlorpheniramine, or chlorcyclizine or apharmaceutically acceptable salt thereof;(vii) a sedative such as glutethimide, meprobamate, methaqualone ordichloralphenazone or a pharmaceutically acceptable salt thereof;(viii) a skeletal muscle relaxant, e.g., baclofen, carisoprodol,chlorzoxazone, cyclobenzaprine, methocarbamol or orphrenadine or apharmaceutically acceptable salt thereof;(ix) an NMDA receptor antagonist, e.g., dextromethorphan((+)-3-hydroxy-N-methylmorphinan) or its metabolite dextrorphan((+)-3-hydroxy-N-methylmorphinan), ketamine, memantine, pyrroloquinolinequinone or cis-4-(phosphonomethyl)-2-piperidinecarboxylic acid or apharmaceutically acceptable salt thereof;(x) an alpha-adrenergic, e.g., doxazosin, tamsulosin, clonidine or4-amino-6,7-dimethoxy-2-(5-methanesulfonamido-1,2,3,4-tetrahydroisoquinol-2-yl)-5-(2-pyridyl)quinazoline;(xi) a COX-2 inhibitor, e.g., celecoxib, rofecoxib or valdecoxib;(xii) a coal-tar analgesic, in particular paracetamol;(xiii) a neuroleptic such as droperidol;(xiv) a vanilloid receptor agonist (e.g., resinferatoxin) or antagonist(e.g., capsazepine);(xv) a local anaesthetic, such as mexiletine;(xxii) a corticosteroid, such as dexamethasone;(xxiii) a serotonin receptor agonist or antagonist;(xxiv) a cholinergic (nicotinic) analgesic;(xxv) tramadol;(xxvi) a PDEV inhibitor, such as sildenafil, vardenafil or taladafil;(xxvii) an alpha-2-delta ligand such as gabapentin or pregabalin; and(xxviii) a cannabinoid.

Those skilled in the art will recognize the difference betweenadministration of a drug for the acute treatment of migraine and formigraine prophylaxis (i.e., for the preventative treatment of migraine).

Those skilled in the art will be able to determine appropriate dosageamounts for particular agents to be used in combination with ananti-CGRP antibody. For example, sumatriptan may be administered in adosage from about 0.01 to about 300 mg. In some cases, sumatriptan maybe administered in a dosage from about 2 mg to about 300 mg, e.g., about5 mg to about 250 mg, about 5 mg to about 200 mg, about 5 mg to about100 mg, about 5 mg to about 50 mg, or about 5 mg to about 25 mg. Whenadministered non-parenterally, the typical dosage of sumatriptan is fromabout 25 to about 100 mg with about 50 mg being generally preferred,e.g., about 45 mg, about 55 mg, or about 60 mg. When sumatriptan isadministered parenterally, the preferred dosage is about 6 mg, e.g.,about 5 mg, about 7 mg, or about 8 mg. However, these dosages may bevaried according to methods standard in the art so that they areoptimized for a particular patient or for a particular combinationtherapy. Further, for example, celecoxib may be administered in anamount of between 50 and 500 mg, e.g., about 50 mg to about 400 mg,about 50 mg to about 300 mg, about 50 mg to about 200 mg, about 50 mg toabout 100 mg, about 100 mg to about 400 mg, or about 200 mg to about 300mg. Further, the label for any approved acute headache medication canalso provide appropriate dosage amounts for the desired result.

In another aspect, the disclosure provides a method of preventing,treating, or reducing incidence of migraine in a subject havingrefractory migraine comprising administering to the subject a monoclonalantibody (e.g., a monoclonal, anti-CGRP antagonist antibody) thatmodulates the CGRP pathway. In some embodiments, the amount of themonoclonal antibody administered on each of the plurality of days may bebetween 0.1 mg-5000 mg, 1 mg-5000 mg, 10 mg-5000 mg, 100 mg-5000 mg,1000 mg-5000 mg, 0.1 mg-4000 mg, 1 mg-4000 mg, 10 mg-4000 mg, 100mg-4000 mg, 1000 mg-4000 mg, 0.1 mg-3000 mg, 1 mg-3000 mg, 10 mg-3000mg, 100 mg-3000 mg, 1000 mg-3000 mg, 0.1 mg-2000 mg, 1 mg-2000 mg, 10mg-2000 mg, 100 mg-2000 mg, 1000 mg-2000 mg, 0.1 mg-1000 mg, 1 mg-1000mg, 10 mg-1000 mg, or 100 mg-1000 mg. In some embodiments, the amount isbetween about 225 mg and about 1000 mg, e.g., about 675 mg or about 900mg. An exemplary dosing regimen comprises administering an initialantibody dose of about 675 mg subcutaneously, followed by a monthlyantibody dose of about 225 mg subcutaneously for, e.g., about twomonths, three months, four months, five months, six months, sevenmonths, eight months, nine months, ten months, 11 months, or 12 months,or even a period of greater than one year (e.g., 18 months, two years,or three years). Another exemplary dosing regimen comprisesadministering an initial antibody dose of about 225 mg subcutaneously,followed by a monthly antibody dose of about 225 mg subcutaneously for,e.g., about two months, three months, four months, five months, sixmonths, seven months, eight months, nine months, ten months, 11 months,or 12 months, or even a period of greater than one year (e.g., 18months, two years, or three years). Yet another dosing regimen comprisesadministering an initial antibody dose of about 900 mg intravenously inan infusion over about 60 minutes, followed by doses of about 900 mgadministered intravenously in an infusion over about 60 minutes everyquarter for, e.g., one year, two years, three years, four years, or fiveyears. Yet another dosing regimen comprises administering an initial orstarting dose of about 675 mg administered subcutaneously, followed bydoses of about 675 mg administered subcutaneously every quarter for,e.g., about one year, two years, three years, four years, or five years.However, other dosage regimens may be useful, depending on the patternof pharmacokinetic decay that the practitioner wishes to achieve. Insome embodiments, the initial dose (i.e., starting dose) and one or moreof the additional doses are administered the same way, e.g.,subcutaneously or intravenously. In some embodiments, the one or moreadditional doses are administered in a different way than the initial orstarting dose, e.g., the initial dose may be administered intravenouslyand the one or more additional doses may be administered subcutaneously.

In another aspect, the disclosure provides a method of preventing,treating, or reducing incidence of migraine in a subject havingrefractory migraine comprising administering to the subject a singledose of a monoclonal antibody (e.g., a monoclonal, anti-CGRP antagonistantibody) in an amount that modulates the CGRP pathway. In someembodiments, the single dose may be an amount of antibody between 0.1mg-5000 mg, 1 mg-5000 mg, 10 mg-5000 mg, 100 mg-5000 mg, 1000 mg-5000mg, 0.1 mg-4000 mg, 1 mg-4000 mg, 10 mg-4000 mg, 100 mg-4000 mg, 1000mg-4000 mg, 0.1 mg-3000 mg, 1 mg-3000 mg, 10 mg-3000 mg, 100 mg-3000 mg,1000 mg-3000 mg, 0.1 mg-2000 mg, 1 mg-2000 mg, 10 mg-2000 mg, 100mg-2000 mg, 1000 mg-2000 mg, 0.1 mg-1000 mg, 1 mg-1000 mg, 10 mg-1000 mgor 100 mg-1000 mg. In some embodiments, the single dose may be an amountof antibody between 225 mg and about 1000 mg, e.g., about 225 mg, about675 mg or about 900 mg. In another embodiment, the single dose may be anamount of antibody between 675 mg and 900 mg.

In another aspect, the disclosure provides a method of preventing,treating, or reducing incidence of migraine in a subject havingrefractory migraine comprising administering to the subject a monthlydose of a monoclonal antibody (e.g., a monoclonal, anti-CGRP antagonistantibody) in an amount that modulates the CGRP pathway. In someembodiments, the single dose may be an amount of antibody between 0.1mg-5000 mg, 1 mg-5000 mg, 10 mg-5000 mg, 100 mg-5000 mg, 1000 mg-5000mg, 0.1 mg-4000 mg, 1 mg-4000 mg, 10 mg-4000 mg, 100 mg-4000 mg, 1000mg-4000 mg, 0.1 mg-3000 mg, 1 mg-3000 mg, 10 mg-3000 mg, 100 mg-3000 mg,1000 mg-3000 mg, 0.1 mg-2000 mg, 1 mg-2000 mg, 10 mg-2000 mg, 100mg-2000 mg, 1000 mg-2000 mg, 0.1 mg-1000 mg, 1 mg-1000 mg, 10 mg-1000 mgor 100 mg-1000 mg. In some embodiments, the monthly dose may be anamount of antibody between about 225 mg and about 1000 mg, e.g., about225 mg, about 675 mg or about 900 mg. An exemplary dosing regimencomprises administering an initial antibody dose of about 675 mgsubcutaneously, followed by a monthly antibody dose of about 225 mgsubcutaneously for, e.g., about two months, three months, four months,five months, six months, seven months, eight months, nine months, tenmonths, 11 months, or 12 months, or even a period of greater than oneyear (e.g., 18 months, two years, or three years). Another exemplarydosing regimen comprises administering an initial antibody dose of about225 mg subcutaneously, followed by a monthly antibody dose of about 225mg subcutaneously for, e.g., about two months, three months, fourmonths, five months, six months, seven months, eight months, ninemonths, ten months, 11 months, or 12 months, or even a period of greaterthan one year (e.g., 18 months, two years, or three years). Yet anotherdosing regimen comprises administering an initial antibody dose of about900 mg intravenously in an infusion over about 60 minutes, followed bydoses of about 900 mg administered intravenously in an infusion overabout 60 minutes every quarter for, e.g., one year, two years, threeyears, four years, or five years. Yet another dosing regimen comprisesadministering an initial or starting dose of about 675 mg administeredsubcutaneously, followed by doses of about 675 mg administeredsubcutaneously every quarter for, e.g., about one year, two years, threeyears, four years, or five years. However, other dosage regimens may beuseful, depending on the pattern of pharmacokinetic decay that thepractitioner wishes to achieve. In some embodiments, the initial dose(i.e., starting dose) and one or more of the additional doses areadministered the same way, e.g., subcutaneously or intravenously. Insome embodiments, the one or more additional doses are administered in adifferent way than the initial or starting dose, e.g., the initial dosemay be administered intravenously and the one or more additional dosesmay be administered subcutaneously.

In another aspect, the disclosure provides a method of decreasing anumber of monthly headache hours experienced by a subject havingrefractory migraine, comprising administering to the subject an amountof a monoclonal antibody (e.g., a monoclonal, anti-CGRP antagonistantibody) that modulates the CGRP pathway. In some embodiments, themonoclonal antibody can be in an amount effective to decrease the numberof monthly headache hours by at least 0.1, 1, 5, 10, 15, 20, 25, 30, 35,40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 or more headachehours after a single dose, monthly dose, or quarterly dose. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the number of monthly headache hours by at least 20 headachehours after a single dose, monthly dose, or quarterly dose. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the number of monthly headache hours by at least 40, 45, 50,55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, ormore headache hours. In some embodiments, the monoclonal antibody can bein an amount effective to decrease the number of monthly headache hoursby at least 0.1%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%,25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%,95%, 99%, or more after a single dose. In some embodiments, themonoclonal can be in an amount effective to decrease the number ofmonthly headache hours by at least 15%, 20%, 25%, 30%, 35%, 40%, 45%,50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or more after asingle dose, monthly dose, or quarterly dose.

In another aspect, the disclosure provides a method of decreasing anumber of monthly headache days experienced by a subject havingrefractory migraine, comprising administering to the subject an amountof a monoclonal antibody (e.g., a monoclonal, anti-CGRP antagonistantibody) that modulates the CGRP pathway. In some embodiments, themonoclonal antibody can be in an amount effective to decrease the numberof monthly headache days by at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, 15, 16, 17, 18, 19, 20, or more headache days after a singledose. In some embodiments, the monoclonal antibody can be in an amounteffective to decrease the number of monthly headache days by at least 3,4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or moreheadache days after a monthly dose or quarterly dose. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the number of monthly headache days by at least 0.1%, 1%, 2%,3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or more after a singledose, monthly dose, or quarterly dose.

In another aspect, the disclosure provides a method of decreasing use ofan acute headache medication in a subject having refractory migraine,comprising administering to the subject a monoclonal antibody (e.g., amonoclonal anti-CGRP antagonist antibody) that modulates the CGRPpathway. In some embodiments, the monoclonal antibody can be in anamount effective to decrease daily, monthly, quarterly, and/or yearlyuse of the anti-headache medication by the subject by at least 0.1%, 1%,2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%,50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or more. In someembodiments, the monoclonal antibody can be in an amount effective todecrease monthly use of the anti-headache medication by the subject byat least 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%,75%, 80%, 85%, 90%, 95%, 99%, or more. The anti-headache medication canbe any type of acute headache medication described herein. The acuteheadache medication can be migraine-specific headache medications, whichare identifiable to one of skill in the art (e.g., triptans and ergotcompounds). Non-limiting examples of acute headache medications include,for example, 5-HT1 agonists (and agonists acting at other 5-HT1 sites),triptans (e.g., sumatriptan, zolmitriptan, naratriptan, rizatriptan,eletriptan, almotriptan, afrovatriptan), ergot alkaloids (e.g.,ergotamine tartrate, ergonovine maleate, and ergoloid mesylates (e.g.,dihydroergocornine, dihydroergocristine, dihydroergocryptine, anddihydroergotamine mesylate (DHE 45)) and non-steroidal anti-inflammatorydrugs (NSAIDs) (e.g., aspirin, diclofenac, diflusinal, etodolac,fenbufen, fenoprofen, flufenisal, flurbiprofen, ibuprofen, indomethacin,ketoprofen, ketorolac, meclofenamic acid, mefenamic acid, nabumetone,naproxen, oxaprozin, phenylbutazone, piroxicam, sulindac, tolmetin orzomepirac, cyclooxygenase-2 (COX-2) inhibitors, celecoxib; rofecoxib;meloxicam; JTE-522; L-745,337; NS398; or a pharmaceutically acceptablesalt thereof), opiates/opiods (e.g., codeine, oxycodone), andbarbituates.

In another aspect, the disclosure provides a method of decreasing themonthly average number of days of use of a migraine-specific acuteheadache medication in a subject having refractory migraine, comprisingadministering to the subject a monoclonal antibody (e.g., a monoclonalanti-CGRP antagonist antibody) that modulates the CGRP pathway. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the monthly average number of days of use of the acute headachemedication by at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16,17, 18, 19, 20, or more days after a single dose. In some embodiments,the monoclonal antibody can be in an amount effective to decrease themonthly average number of days of use of the acute headache medicationby at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19,20, or more days after a monthly dose or quarterly dose. In someembodiments, the migraine-specific acute headache medication is atriptan or ergot compound.

In another aspect, the disclosure provides a method of decreasing themonthly average number of days with nausea and/or vomiting experiencedby a subject having refractory migraine, comprising administering to thesubject an amount of a monoclonal antibody (e.g., a monoclonal,anti-CGRP antagonist antibody) that modulates the CGRP pathway. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the number of monthly nausea and/or vomiting days by at least3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or morenausea and/or vomiting days after a single dose. In some embodiments,the monoclonal antibody can be in an amount effective to decrease thenumber of monthly nausea and/or vomiting days by at least 3, 4, 5, 6, 7,8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more nausea and/orvomiting days after a monthly dose or quarterly dose. In someembodiments, the monoclonal antibody can be in an amount effective todecrease the number of monthly nausea and/or vomiting days by at least0.1%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%,40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or moreafter a single dose, monthly dose, or quarterly dose.

In another aspect, the disclosure provides a method of decreasing themonthly average number of days with photophobia and/or phonophobiaexperienced by a subject having refractory migraine, comprisingadministering to the subject an amount of a monoclonal antibody (e.g., amonoclonal, anti-CGRP antagonist antibody) that modulates the CGRPpathway. In some embodiments, the monoclonal antibody can be in anamount effective to decrease the number of monthly photophobia and/orphonophobia days by at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, 16, 17, 18, 19, 20, or more photophobia and/or phonophobia daysafter a single dose. In some embodiments, the monoclonal antibody can bein an amount effective to decrease the number of monthly photophobiaand/or phonophobia days by at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19, 20, or more photophobia and/or phonophobia daysafter a monthly dose or quarterly dose. In some embodiments, themonoclonal antibody can be in an amount effective to decrease the numberof monthly photophobia and/or phonophobia days by at least 0.1%, 1%, 2%,3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or more after a singledose, monthly dose, or quarterly dose.

In another aspect, the disclosure provides a method of improving thequality of life of a subject having refractory migraine, comprisingadministering to the subject a monoclonal antibody (e.g., a monoclonalanti-CGRP antagonist antibody) that modulates the CGRP pathway. In someembodiments, changes in quality of life are self-reported by thesubject. In some embodiments, changes in the quality of life of asubject are measured using a Migraine-Specific Quality of Life (MSQOL)questionnaire. The MSQOL questionnaire, and various versions thereof,are known in the art.

In another aspect, the disclosure provides a method of improving thehealth-related quality of life of a subject, comprising administering tothe subject a monoclonal antibody (e.g., a monoclonal anti-CGRPantagonist antibody) that modulates the CGRP pathway. In someembodiments, changes in health-related quality of life are self-reportedby the subject. In some embodiments, changes in the health-relatedquality of life of a subject are measured using a EuroQol-5 Dimension(EQ 5D) questionnaire. The EQ 5D questionnaire, and various versionsthereof, are known in the art.

In another aspect, the disclosure provides a method of reducing thedisability due to migraine of a subject having refractory migraine,comprising administering to the subject a monoclonal antibody (e.g., amonoclonal anti-CGRP antagonist antibody) that modulates the CGRPpathway. In some embodiments, changes in disability due to migraine areself-reported by the subject. In some embodiments, changes in disabilitydue to migraine of a subject are measured using a 6-item Headache ImpactTest (HIT-6). The HIT-6, and various versions thereof, are known in theart.

In another aspect, the disclosure provides a method of reducing thedisability due to migraine of a subject having refractory migraine,comprising administering to the subject a monoclonal antibody (e.g., amonoclonal anti-CGRP antagonist antibody) that modulates the CGRPpathway. In some embodiments, changes in disability due to migraine areself-reported by the subject. In some embodiments, changes in disabilitydue to migraine of a subject are measured using a Migraine DisabilityAssessment (MIDAS) questionnaire. The MIDAS questionnaire, and variousversions thereof, are known in the art.

In another aspect, the disclosure provides a method of reducingdepression in a subject, comprising administering to the subject havingrefractory migraine a monoclonal antibody (e.g., a monoclonal anti-CGRPantagonist antibody) that modulates the CGRP pathway. In someembodiments, changes in depression status are self-reported by thesubject. In some embodiments, changes in the depression status of asubject are measured using the two-item Patient Health Questionnaire(PHQ-2) or the nine-item Patient Health Questionnaire (PHQ-9). In someembodiments, changes in the depression status of a subject are measuredusing the two-item Patient Health Questionnaire (PHQ-2) and thenine-item Patient Health Questionnaire (PHQ-9).

In another aspect, the disclosure provides a method of improving thework productivity and activity of a subject having refractory migraine,comprising administering to the subject a monoclonal antibody (e.g., amonoclonal anti-CGRP antagonist antibody) that modulates the CGRPpathway. In some embodiments, changes in work productivity and activityare self-reported by the subject. In some embodiments, changes in thethe work productivity and activity of a subject are measured using theWork Productivity and Activity Impairment (WPAI) questionnaire. The WPAIquestionnaire, and various versions thereof, are known in the art.

With respect to all methods described herein, references to antibodies(e.g., monoclonal antibodies that modulate the CGRP pathway, anti-CGRPantagonist antibodies, monoclonal anti-CGRP antagonist antibodies) alsoinclude compositions comprising one or more of these agents.Accordingly, such a composition may be used according to a methodreferring to an antibody described herein. These compositions mayfurther comprise suitable excipients, such as pharmaceuticallyacceptable excipients as described elsewhere herein.

An antibody described herein (e.g., a monoclonal antibody, an anti-CGRPantagonist antibody, a monoclonal anti-CGRP antagonist antibody) can beadministered to an individual or subject in any therapeutic dose, viaany suitable route and in any suitable formulation. It should beapparent to a person skilled in the art that the examples describedherein are not intended to be limiting but to be illustrative of thetechniques available. Accordingly, in some embodiments, an antibodydescribed herein can be administered to a subject in accord with knownmethods, such as intravenous administration, e.g., as a bolus or bycontinuous infusion over a period of time, e.g., about 10 minutes, about20 minutes, about 30 minutes, about 40 minutes, about 50 minutes, about60 minutes, about 90 minutes, about 120 minutes, about 180 minutes, orabout 240 minutes. The antibody described herein can also beadministered to the subject by subcutaneous, intramuscular,intraperitoneal, intracerebrospinal, intra-articular, sublingually,intra-arterial, intrasynovial, via insufflation, intrathecal, oral,inhalation, intranasal (e.g., with or without inhalation), buccal,rectal, transdermal, intracardiac, intraosseous, intradermal,transmucosal, vaginal, intravitreal, peri-articular, local,epicutaneous, or topical routes. Administration can be systemic, e.g.,intravenous administration, or localized. Commercially availablenebulizers for liquid formulations, including jet nebulizers andultrasonic nebulizers are useful for administration. Liquid formulationscan be directly nebulized and lyophilized powder can be nebulized afterreconstitution. Alternatively, an antibody described herein can beaerosolized using a fluorocarbon formulation and a metered dose inhaler,or inhaled as a lyophilized and milled powder.

In some embodiments, an antibody described herein can be administeredvia site-specific or targeted local delivery techniques. Examples ofsite-specific or targeted local delivery techniques include variousimplantable depot sources of the antibody or local delivery catheters,such as infusion catheters, an indwelling catheter, or a needlecatheter, synthetic grafts, adventitial wraps, shunts and stents orother implantable devices, site specific carriers, direct injection, ordirect application. See e.g., PCT Publication No. WO 00/53211 and U.S.Pat. No. 5,981,568, which are hereby incorporated by reference in theirentireties.

Various formulations of an antibody described herein may be used foradministration. In some embodiments, an antibody may be administeredneat. In some embodiments, antibody and a pharmaceutically acceptableexcipient may be in various formulations. Pharmaceutically acceptableexcipients are known in the art, and are relatively inert substancesthat facilitate administration of a pharmacologically effectivesubstance. For example, an excipient can give form or consistency, oract as a diluent. Suitable excipients include but are not limited tostabilizing agents, wetting and emulsifying agents, salts for varyingosmolarity, encapsulating agents, buffers, and skin penetrationenhancers. Excipients as well as formulations for parenteral andnonparenteral drug delivery are set forth in Remington, The Science andPractice of Pharmacy 20th Ed. Mack Publishing (2000).

In some embodiments, these agents, including antibodies describedherein, may be formulated for administration by injection (e.g.,intravenously, subcutaneously, intraperitoneally, intramuscularly,etc.). Accordingly, these agents can be combined with pharmaceuticallyacceptable vehicles such as saline, Ringer's solution, dextrosesolution, and the like. The particular dosage regimen, i.e., dose,timing and repetition, will depend on the particular individual and thatindividual's medical history.

In some embodiments, these agents, including antibodies describedherein, may be formulated for peripheral administration. Suchformulations can be administered peripherally via any suitableperipheral route, including intravenously and subcutaneously. An agentprepared for peripheral administration can include a substance,medicament, and/or antibody that is not delivered centrally, spinally,intrathecally, or directly into the CNS. Non-limiting examples ofperipheral administration routes include a route which is oral,sublingual, buccal, topical, rectal, via inhalation, transdermal,subcutaneous, intravenous, intra-arterial, intramuscular, intracardiac,intraosseous, intradermal, intraperitoneal, transmucosal, vaginal,intravitreal, intra-articular, peri-articular, local, or epicutaneous.

Therapeutic formulations of the antibodies used in accordance with thepresent disclosure can be prepared for storage and/or use by mixing anantibody having the desired degree of purity with optionalpharmaceutically acceptable carriers, excipients or stabilizers(Remington, The Science and Practice of Pharmacy 20th Ed. MackPublishing (2000)), and can in some cases be in the form of lyophilizedformulations or aqueous solutions. Acceptable carriers, excipients, orstabilizers are nontoxic to recipients at the dosages and concentrationsemployed. A therapeutic formulation of an antibody may comprise one ormore pharmaceutically acceptable carriers, excipients or stabilizes withnon-limiting examples of such species that include buffers such asphosphate, citrate, and other organic acids; salts such as sodiumchloride; antioxidants including ascorbic acid and methionine;preservatives (such as octadecyldimethylbenzyl ammonium chloride;hexamethonium chloride; benzalkonium chloride, benzethonium chloride;phenol, butyl or benzyl alcohol; alkyl parabens, such as methyl orpropyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; andm-cresol); low molecular weight (less than about 10 residues)polypeptides; proteins, such as serum albumin, gelatin, orimmunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone;amino acids (e.g., at concentrations of 0.1 mM to 100 mM, 0.1 mM to 1mM, 0.01 mM to 50 mM, 1 mM to 50 mM, 1 mM to 30 mM, 1 mM to 20 mM, 10 mMto 25 mM) such as glycine, glutamine, methionine, asparagine, histidine,arginine, or lysine; monosaccharides, disaccharides, and othercarbohydrates including glucose, mannose, or dextrins; chelating agents(e.g., at concentrations of 0.001 mg/mL to 1 mg/mL, 0.001 mg/mL to 1mg/mL, 0.001 mg/mL to 0.1 mg/mL, 0.001 mg/mL to 0.01 mg/mL, 0.01 mg/mLto 0.1 mg/mL) such as EDTA (e.g., disodium EDTA dihydrate); sugars(e.g., at concentrations of 1 mg/mL to 500 mg/mL, 10 mg/mL to 200 mg/mL,10 mg/mL to 100 mg/mL, 50 mg/mL to 150 mg/mL) such as sucrose, mannitol,trehalose or sorbitol; salt-forming counter-ions such as sodium; metalcomplexes (e.g., Zn-protein complexes); and/or non-ionic surfactants(e.g., at concentrations of 0.01 mg/mL to 10 mg/mL, 0.01 mg/mL to 1mg/mL, 0.1 mg/mL to 1 mg/mL, 0.01 mg/mL to 0.5 mg/mL) such as TWEEN™(e.g., polysorbate (e.g., polysorbate 20, polysorbate 40, polysorbate60, polysorbate 80)), PLURONICS™ or polyethylene glycol (PEG).

An antibody formulation may be characterized in terms of any of avariety of physical properties. For example, a liquid antibodyformulation may have any suitable pH for therapeutic efficacy, safetyand storage. For example, the pH of a liquid antibody formulation may befrom pH 4 to about pH 9, from about pH 5 to about pH 8, from about pH 5to about pH 7 or from about pH 6 to about pH 8. In some embodiments, aliquid antibody formulation may have a pH of about 3.0, 3.5, 4.0, 4.5,5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, or about 10 or higheror lower.

In another example, a liquid antibody formulation may have any suitableviscosity for therapeutic efficacy, safety and storage. For example, theviscosity of a liquid antibody formulation may be from about 0.5centipoise (cP) to about 100 cP, about 1 cP to about 50 cP, about 1 cPto about 20 cP, about 1 cP to about 15 cP, or about 5 cP to about 15 cPat 25° C. In some embodiments, a liquid antibody formulation may have aviscosity of about 0.5 cP, 1 cP, 1.2 cP, 1.4 cP, 1.6 cP, 1.8 cP, 2.0 cP,2.2 cP, 2.4 cP, 2.6 cP, 2.8 cP, 3.0 cP, 3.2 cP, 3.4 cP, 3.6 cP, 3.8 cP,4.0 cP, 4.2 cP, 4.4 cP, 4.6 cP, 4.8 cP, 5.0 cP, 5.2 cP, 5.4 cP, 5.6 cP,5.8 cP, 6.0 cP, 6.2 cP, 6.4 cP, 6.6 cP, 6.8 cP, 7.0 cP, 7.2 cP, 7.4 cP,7.6 cP, 7.8 cP, 8.0 cP, 8.2 cP, 8.4 cP, 8.6 cP, 8.8 cP, 9.0 cP, 9.2 cP,9.4 cP, 9.6 cP, 9.8 cP, 10.0 cP, 10.2 cP, 10.4 cP, 10.6 cP, 10.8 cP,11.0 cP, 11.2 cP, 11.4 cP, 11.6 cP, 11.8 cP, 12.0 cP, 12.2 cP, 12.4 cP,12.6 cP, 12.8 cP, 13.0 cP, 13.2 cP, 13.4 cP, 13.6 cP, 13.8 cP, 14.0 cP,14.2 cP, 14.4 cP, 14.6 cP, 14.8 cP, or about 15.0 cP at 25° C. or theviscosity may be higher or lower.

In another example, a liquid antibody formulation may have any suitableconductivity for therapeutic efficacy, safety and storage. For example,the conductivity of a liquid antibody formulation may be from about 0.1millisiemens per centimeter (mS/cm) to about 15 mS/cm, 0.1 mS/cm to 10mS/cm, 0.1 mS/cm to 5 mS/cm, 0.1 mS/cm to 2 mS/cm or 0.1 mS/cm to 1.5mS/cm. In some embodiments, a liquid antibody formulation may have aconductivity of 0.19 mS/cm, 0.59 mS/cm, 1.09 mS/cm, 1.19 mS/cm, 1.29mS/cm, 1.39 mS/cm, 1.49 mS/cm, 1.59 mS/cm, 1.69 mS/cm, 1.79 mS/cm, 1.89mS/cm, 1.99 mS/cm, 2.09 mS/cm, 2.19 mS/cm, 2.29 mS/cm, 2.39 mS/cm, 2.49mS/cm, 2.59 MS/CM, 2.69 mS/cm, 2.79 mS/cm, 2.89 mS/cm, 2.99 mS/cm, 3.09mS/cm, 3.19 mS/cm, 3.29 mS/cm, 3.39 mS/cm, 3.49 mS/cm, 3.59 mS/cm, 3.69mS/cm, 3.79 mS/cm, 3.89 mS/cm, 3.99 mS/cm, 4.09 mS/cm, 4.19 mS/cm, 4.29mS/cm, 4.39 mS/cm, 4.49 mS/cm, 4.59 mS/cm, 4.69 mS/cm, 4.79 mS/cm, 4.89mS/cm, 4.99 mS/cm, 5.09 mS/cm, 6.09 mS/cm, 6.59 mS/cm, 7.09 mS/cm, 7.59mS/cm, 8.09 mS/cm, 8.59 mS/cm, 9.09 mS/cm, 9.59 mS/cm, 10.09 mS/cm,10.59 mS/cm, 11.09 mS/cm, 11.59 mS/cm, 12.09 mS/cm, 12.59 mS/cm, 13.09mS/cm, 13.59 mS/cm, 14.09 mS/cm, 14.59 mS/cm, or about 15.09 mS/cm orthe conductivity may be higher or lower.

In another example, a liquid antibody formulation may have any suitableosmolality for therapeutic efficacy, safety, and storage. For example,the osmolality of a liquid antibody formulation may be from about 50milliosmole per kilogram (mOsm/kg) to about 5000 mOsm/kg, about 50mOsm/kg to about 2000 mOsm/kg, about 50 mOsm/kg to about 1000 mOsm/kg,about 50 mOsm/kg to about 750 mOsm/kg, or about 50 mOsm/kg to about 500mOsm/kg. In some embodiments, a liquid antibody formulation may have anosmolality of about 50 mOsm/kg, 60 mOsm/kg, 70 mOsm/kg, 80 mOsm/kg, 90mOsm/kg, 100 mOsm/kg 120 mOsm/kg, 140 mOsm/kg, 160 mOsm/kg, 180 mOsm/kg,200 mOsm/kg, 220 mOsm/kg, 240 mOsm/kg, 260 mOsm/kg, 280 mOsm/kg, 300mOsm/kg, 320 mOsm/kg, 340 mOsm/kg, 360 mOsm/kg, 380 mOsm/kg, 400mOsm/kg, 420 mOsm/kg, 440 mOsm/kg, 460 mOsm/kg, 480 mOsm/kg, 500mOsm/kg, 520 mOsm/kg, 540 mOsm/kg, 560 mOsm/kg, 580 mOsm/kg, 600mOsm/kg, 620 mOsm/kg, 640 mOsm/kg, 660 mOsm/kg, 680 mOsm/kg, 700mOsm/kg, 720 mOsm/kg, 740 mOsm/kg, 760 mOsm/kg, 780 mOsm/kg, 800mOsm/kg, 820 mOsm/kg, 840 mOsm/kg, 860 mOsm/kg, 880 mOsm/kg, 900mOsm/kg, 920 mOsm/kg, 940 mOsm/kg, 960 mOsm/kg, 980 mOsm/kg, 1000mOsm/kg, 1050 mOsm/kg, 1100 mOsm/kg, 1150 mOsm/kg, 1200 mOsm/kg, 1250mOsm/kg, 1300 mOsm/kg, 1350 mOsm/kg, 1400 mOsm/kg, 1450 mOsm/kg, about1500 mOsm/kg, or the osmolality may be higher or lower.

Liposomes containing antibody can be prepared by methods known in theart, such as described in Epstein, et al., Proc. Natl. Acad. Sci. USA82:3688 (1985); Hwang, et al., Proc. Natl Acad. Sci. USA 77:4030 (1980);and U.S. Pat. Nos. 4,485,045 and 4,544,545. Liposomes with enhancedcirculation time are disclosed in U.S. Pat. No. 5,013,556. Particularlyuseful liposomes can be generated by the reverse phase evaporationmethod with a lipid composition comprising phosphatidylcholine,cholesterol and PEG-derivatized phosphatidylethanolamine (PEG-PE).Liposomes are extruded through filters of defined pore size to yieldliposomes with the desired diameter.

The active ingredients may also be entrapped in microcapsules prepared,for example, by coacervation techniques or by interfacialpolymerization, for example, hydroxymethylcellulose orgelatin-microcapsules and poly-(methylmethacylate) microcapsules,respectively, in colloidal drug delivery systems (for example,liposomes, albumin microspheres, microemulsions, nano-particles andnanocapsules) or in macroemulsions. Such techniques are disclosed inRemington, The Science and Practice of Pharmacy 20th Ed. Mack Publishing(2000).

Sustained-release preparations may be prepared. Suitable examples ofsustained-release preparations include semipermeable matrices of solidhydrophobic polymers containing the antibody, which matrices are in theform of shaped articles, e.g., films, or microcapsules. Examples ofsustained-release matrices include polyesters, hydrogels (for example,poly(2-hydroxyethyl-methacrylate), or ‘poly(v nylalcohol)), polylactides(U.S. Pat. No. 3,773,919), copolymers of L-glutamic acid and 7ethyl-L-glutamate, non-degradable ethylene-vinyl acetate, degradablelactic acid-glycolic acid copolymers such as the LUPRON DEPOT™(injectable microspheres composed of lactic acid-glycolic acid copolymerand leuprolide acetate), sucrose acetate isobutyrate, andpoly-D-(−)-3-hydroxybutyric acid.

The formulations to be used for in vivo administration should generallybe sterile. This is readily accomplished by, for example, filtrationthrough sterile filtration membranes. Therapeutic antibody compositionsare generally placed into a container having a sterile access port, forexample, an intravenous solution bag or vial having a stopper pierceableby a hypodermic injection needle.

The compositions according to the present invention may be in unitdosage forms such as tablets, pills, capsules, powders, granules,solutions or suspensions, or suppositories, for oral, parenteral orrectal administration, or administration by inhalation or insufflation.In some cases, a unit dosage form may be supplied in a prefilledreceptacle (e.g., a prefilled syringe) useful in administering the unitdosage to a subject.

In some embodiments, a formulation comprising an antibody (e.g.,monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein may be prepared for any suitable route of administration with anantibody amount ranging from about 0.1 mg to about 3000 mg, about 1 mgto about 1000 mg, about 100 mg to about 1000 mg, or about 100 mg toabout 500 mg, about 200 mg to about 800 mg, about 500 mg to about 1500mg, about 1500 mg to about 2500 mg, or about 2000 mg to about 3000 mg.In some cases, a formulation comprising an antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein may comprisean antibody amount of, at most, or at least about 0.1 mg, 1 mg, 100 mg,1 mg, 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg, 175 mg, 200mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 450mg, 475 mg, 500 mg, 525 mg, 550 mg, 575 mg, 600 mg, 625 mg, 650 mg, 675mg, 700 mg, 725 mg, 750 mg, 775 mg, 800 mg, 825 mg, 850 mg, 875 mg, 900mg, 925 mg, 950 mg, 975 mg, 1000 mg, 1100 mg, 1200 mg, 1300 mg, 1400 mg,1500 mg, 1600 mg, 1700 mg, 1800 mg, 1900 mg, 2000 mg, or about 3000 mg.

In some embodiments, a liquid formulation comprising an antibody (e.g.,monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein may be prepared for any suitable route of administration with anantibody concentration ranging from about 0.1 mg/mL to about 500 mg/mL,about 0.1 mg/mL to about 375 mg/mL, about 0.1 mg/mL to about 250 mg/mL,about 0.1 to about 175 mg/mL, about 0.1 to 100 mg/mL, about 1 mg/mL toabout 500 mg/mL, about 1 mg/mL to about 375 mg/mL, about 1 mg/mL toabout 300 mg/mL, about 1 mg/mL to 250 mg/mL, about 1 mg/mL to 200 mg/mL,about 1 mg/mL to 150 mg/mL, about 1 mg/mL to about 100 mg/mL, about 10mg/mL to 500 mg/mL, about 10 mg/mL to about 375 mg/mL, about 10 mg/mL to250 mg/mL, about 10 mg/mL to about 150 mg/mL, about 10 mg/mL to 100mg/mL, about 100 mg/mL to 500 mg/mL, about 100 mg/mL to 450 mg/mL, about100 mg/mL to 400 mg/mL, about 100 mg/mL to about 350 mg/mL, about 100mg/mL to about 300 mg/mL, about 100 mg/mL to about 250 mg/mL, 100 mg/mLto 200 mg/mL, or about 100 mg/mL to about 150 mg/mL. In someembodiments, a liquid formulation may comprise an antibody describedherein at a concentration of, of at most, of at least, or less thanabout 0.1, 0.5, 1, 5, 10, 15 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70,75, 80, 85, 90, 95, 100, 105 110, 115, 120, 125, 130, 135, 140, 145,150, 155, 160, 165, 170, 175, 180, 185, 190, 195, 200, 210, 220, 230,240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370,380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, or about 500mg/mL.

An antibody formulation may comprise one or more components includingthe antibody and other species described elsewhere herein. The antibodyand other components may be in any suitable amount and/or any suitableconcentration for therapeutic efficacy of the antibody, safety andstorage. In one example, an antibody formulation may be a solutioncomprising about 51.4 mg/mL antibody (e.g., antibody G1, anotheranti-CGRP antagonist antibody, or a monoclonal antibody that modulatesthe CGRP pathway), 16-20 mM histidine, 0.1 mg/mL methionine, 84 mg/mLtrehalose dihydrate, 0.05 mg/mL disodium EDTA dihydrate, and 0.2 mg/mLpolysorbate 80.

In another example, an antibody formulation may comprise about 200 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 15 mM arginine, 78mg/mL sucrose, 0.3 mg/mL EDTA, and 0.1 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 175 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 20 mM glycine, 88mg/mL trehalose dihydrate, 0.015 mg/mL EDTA, and 0.25 mg/mL polysorbate80.

In another example, an antibody formulation may comprise about 225 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 23 mM asparagine,84 mg/mL sorbitol, 0.1 mg/mL EDTA, and 0.15 mg/mL polysorbate 60.

In another example, an antibody formulation may comprise about 150 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 17 mM asparagine,74 mg/mL mannitol, 0.025 mg/mL EDTA, and 0.2 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 100 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 16 mM arginine, 87mg/mL mannitol, 0.025 mg/mL EDTA, and 0.15 mg/mL polysorbate 20.

In another example, an antibody formulation may comprise about 250 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 25 mM histidine,74 mg/mL mannitol, 0.025 mg/mL EDTA, and 0.25 mg/mL polysorbate 20.

In another example, an antibody formulation may comprise about 50 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 19 mM arginine, 84mg/mL sucrose, 0.05 mg/mL EDTA, and 0.3 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 125 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 22 mM glycine, 79mg/mL trehalose dihydrate, 0.15 mg/mL EDTA, and 0.15 mg/mL polysorbate80.

In another example, an antibody formulation may be a solution comprisingabout 175 mg/mL antibody (e.g., antibody G1, another anti-CGRPantagonist antibody, or a monoclonal antibody that modulates the CGRPpathway), 20 mM histidine, 0.1 mg/mL methionine, 84 mg/mL trehalosedihydrate, 0.05 mg/mL disodium EDTA dihydrate, and 0.2 mg/mL polysorbate80.

In another example, an antibody formulation may comprise about 200 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 30 mM arginine, 78mg/mL sucrose, 0.3 mg/mL EDTA, and 0.1 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 175 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 20 mM glycine, 88mg/mL trehalose dihydrate, 0.015 mg/mL EDTA, and 0.15 mg/mL polysorbate80.

In another example, an antibody formulation may comprise about 150 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 20 mM histidine,84 mg/mL sucrose, 0.05 mg/mL EDTA, and 0.2 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 225 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 23 mM histidine,84 mg/mL sorbitol, 0.1 mg/mL EDTA, and 0.15 mg/mL polysorbate 60.

In another example, an antibody formulation may comprise about 150 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 17 mM asparagine,74 mg/mL mannitol, 0.3 mg/mL EDTA, and 0.2 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise about 100 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 16 mM arginine, 87mg/mL mannitol, 0.025 mg/mL EDTA, and 0.25 mg/mL polysorbate 20.

In another example, an antibody formulation may comprise about 250 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 25 mM histidine,89 mg/mL mannitol, 0.025 mg/mL EDTA, and 0.25 mg/mL polysorbate 20.

In another example, an antibody formulation may comprise 125 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 29 mM arginine, 84mg/mL sucrose, 0.05 mg/mL EDTA, and 0.3 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise 150 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 25 mM asparagine,84 mg/mL mannitol, 0.05 mg/mL EDTA, and 0.2 mg/mL polysorbate 80.

In another example, an antibody formulation may comprise 145 mg/mLantibody (e.g., antibody G1, another anti-CGRP antagonist antibody, or amonoclonal antibody that modulates the CGRP pathway), 22 mM histidine,72 mg/mL trehalose dihydrate, 0.05 mg/mL EDTA, and 0.1 mg/mL polysorbate80.

An antibody described herein can be administered using any suitablemethod, including by injection (e.g., intravenously, subcutaneously,intraperitoneally, intramuscularly, etc.). Antibodies can also beadministered via inhalation, as described herein. In some cases, anantibody may be administered nasally with or without inhalation.Generally, for administration of an antibody described herein, aninitial candidate dosage can be about 2 mg/kg. For the purpose of thepresent invention, a typical daily dosage might range from about any of3 pg/kg to 30 pg/kg to 300 pg/kg to 3 mg/kg, to 30 mg/kg to 100 mg/kg ormore, depending on the factors mentioned above. For example, dosage ofabout 1 mg/kg, about 2.5 mg/kg, about 5 mg/kg, about 10 mg/kg, about 25mg/kg, and about 30 mg/kg may be used. For repeated administrations overseveral days or longer, depending on the condition, the treatment issustained until a desired suppression of symptoms occurs or untilsufficient therapeutic levels are achieved, for example, to reduce pain.An exemplary dosing regimen comprises administering an initial orstarting dose of about 8.5 mg/kg, or about 10 mg/kg, followed by amaintenance dose of about 2.8 mg/kg of an antibody, or followed by amaintenance dose of about 2.8 mg/kg every other week. Another exemplarydosing regimen comprises administering a dose of about 100 mg, 125 mg,150 mg, 200 mg, 225 mg, 250 mg, 275 mg, 300 mg, 350 mg, 400 mg, 450 mg,500 mg, 550 mg, 600 mg, about 675 mg, or about 900 mg to a subject onceper month (e.g., approximately every 28 days) intravenously in aninfusion over about one hour, or subcutaneously. For example, anexemplary dosing regimen can comprise administering an initial antibodydose of about 225 mg subcutaneously, followed by a monthly antibody doseof about 225 mg subcutaneously for, e.g., about two months, threemonths, four months, five months, six months, seven months, eightmonths, nine months, ten months, 11 months, or 12 months, or even aperiod of greater than one year (e.g., 18 months, two years, or threeyears). Another exemplary dosing regimen comprises administering aninitial antibody dose of about 675 mg subcutaneously, followed by amonthly antibody dose of about 225 mg subcutaneously for, e.g., abouttwo months, three months, four months, five months, six months, sevenmonths, eight months, nine months, ten months, 11 months, or 12 months,or even a period of greater than one year (e.g., 18 months, two years,or three years). Yet another dosing regimen comprises administering aninitial or starting dose of about 900 mg intravenously in an infusionover about 60 minutes, followed by doses of about 900 mg administeredintravenously in an infusion over about 60 minutes every quarter for,e.g., one year, two years, three years, four years, or five years. Yetanother dosing regimen comprises administering an initial or startingdose of about 675 mg administered subcutaneously, followed by doses ofabout 675 mg administered subcutaneously every quarter for, e.g., aboutone year, two years, three years, four years, or five years. However,other dosage regimens may be useful, depending on the pattern ofpharmacokinetic decay that the practitioner wishes to achieve. Forexample, in some embodiments, dosing from about one to about four timesa week is contemplated. The progress of this therapy is easily monitoredby conventional techniques and assays. The dosing regimen (including theCGRP antagonist(s) used) can vary over time.

In some embodiments, the dose or amount of an antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein andadministered to a subject may range from about 0.1 μg to about 3000 mg,1 mg to 1000 mg, 100 mg to 1000 mg, 100 mg to 500 mg, 0.1 mg to 5000 mg,1 mg to 4000 mg, 250 mg to 1000 mg, 500 mg to 1000 mg, 100 mg to 900 mg,400 mg to 900 mg, 10 mg to 3000 mg, 10 mg to 2000 mg, 100 mg to 2000 mg,150 mg to 2000 mg, 200 mg to 2000 mg, 250 mg to 2000 mg, 300 mg to 2000mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450 mg to 2000 mg, 500 mg to2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg, 650 mg to 2000 mg, 700 mgto 2000 mg, 750 mg to 2000 mg, 800 mg to 2000 mg, 850 mg to 2000 mg, 900mg to 2000 mg, 950 mg to 2000 mg, or 1000 mg to 2000 mg. In someembodiments, the dose or amount of an antibody described herein andadministered to a subject may be, may be at most, may be less than, ormay be at least about 0.1 μg, 1 μg, 100 μg, 1 mg, 10 mg, 25 mg, 50 mg,75 mg, 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, 250 mg, 275 mg,300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 450 mg, 475 mg, 500 mg, 525 mg,550 mg, 575 mg, 600 mg, 625 mg, 650 mg, 675 mg, 700 mg, 725 mg, 750 mg,775 mg, 800 mg, 825 mg, 850 mg, 875 mg, 900 mg, 925 mg, 950 mg, 975 mg,1000 mg, 1100 mg, 1200 mg, 1300 mg, 1400 mg, 1500 mg, 1600 mg, 1700 mg,1800 mg, 1900 mg, 2000 mg, or about 3000 mg. In some embodiments, theamount is between about 225 mg to about 1000 mg, e.g., about 225 mg,about 675 mg or about 900 mg. An exemplary dosing regimen comprisesadministering an initial antibody dose of about 225 mg subcutaneously,followed by a monthly antibody dose of about 225 mg subcutaneously for,e.g., about two months, three months, four months, five months, sixmonths, seven months, eight months, nine months, ten months, 11 months,or 12 months, or even a period of greater, than one year (e.g., 18months, two years, or three years). An exemplary dosing regimencomprises administering an initial antibody dose of about 675 mgsubcutaneously, followed by a monthly antibody dose of about 225 mgsubcutaneously for, e.g., about two months, three months, four months,five months, six months, seven months, eight months, nine months, tenmonths, 11 months, or 12 months, or even a period of greater than oneyear (e.g., 18 months, two years, or three years). Yet another dosingregimen comprises administering an initial or starting dose of about 900mg intravenously in an infusion over about 60 minutes, followed by dosesof about 900 mg administered intravenously in an infusion over about 60minutes every quarter for, e.g., one year, two years, three years, fouryears, or five years. Yet another dosing regimen comprises administeringan initial or starting dose of about 675 mg administered subcutaneously,followed by doses of about 675 mg administered subcutaneously everyquarter for, e.g., about one year, two years, three years, four years,or five years. However, other dosage regimens may be useful, dependingon the pattern of pharmacokinetic decay that the practitioner wishes toachieve.

In some embodiments, the dose or amount of an antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein andadministered to a subject may range from about 0.1 to 500, 0.1 to 100,0.1 to 50, 0.1 to 20, 0.1 to 10, 1 to 10, 1 to 7, 1 to 5 or 0.1 to 3mg/kg of body weight. In some embodiments, the dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)described herein and administered to a subject may be, may be at most,may be less than, or may be at least about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6,0.7, 0.8, 0.9, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0,6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0, 10.5, 11.0, 11.5, 12.0, 12.5,13.0, 13.5, 14.0, 14.5, 15.0, 15.5, 16.0, 16.5, 17.0, 17.5, 18.0, 18.5,19.0, 19.5, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34,35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 55, 60,65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180,190, 200, 225, 250, 275, 300, 325, 350, 375, 400, 425, 450, 475, orabout 500 mg/kg of body weight.

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)described herein is administered to a subject may vary. In someembodiments, a single dose of antibody may be given to a subject acrosstherapy. In some embodiments, the frequency at which a dose or amount ofan antibody is administered to a subject is constant (e.g., administeredabout once per month or about once per quarter). In some embodiments,the frequency at which a dose or amount of an antibody is administeredto a subject is about every quarter for about one year, two years, threeyears, four years, or five years. In some embodiments, the frequency atwhich a dose or amount of an antibody described herein is administeredto a subject is variable (e.g., an initial or starting dose followed bya dose at once per month, followed by additional doses at about threemonths and about seven months). In some embodiments, the frequency atwhich an antibody is administered to a subject is, is at least, is lessthan, or is at most about one, two, three, four, five, or six time(s)per day. In some embodiments, the frequency at which an antibody (e.g.,monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) isadministered to a subject is, is at least, is less than, or is at mostabout one, two, three, four, five, or six dose(s) per day.

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)described herein is administered to a subject is, is at least, is lessthan, or is at most one, two, three, four, five, six, seven, eight,nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen,seventeen, eighteen, nineteen, or twenty time(s) per every one, two,three, four, five, six, seven, eight, nine, ten, eleven, twelve,thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen,twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five,twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty, thirty-one,thirty-two, thirty-three, thirty-four, thirty-five, thirty-six,thirty-seven, thirty-eight, thirty-nine, forty, forty-one, forty-two,forty-three, forty-four, forty-five, forty-six, forty-seven,forty-eight, forty-nine, fifty, fifty-five, sixty, sixty-five, seventy,seventy-five, eighty, eighty-five, ninety, ninety-five, one-hundred,one-hundred twenty-five, one-hundred fifty, one-hundred eighty, ortwo-hundred day(s).

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)described herein is administered to a subject is, is at least, is lessthan, or is at most one, two, three, four, five, six, seven, eight,nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen,seventeen, eighteen, nineteen, or twenty time(s) per every one, two,three, four, five, six, seven, eight, nine, ten, eleven, twelve,thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen,twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five,twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty, thirty-one,thirty-two, thirty-three, thirty-four, thirty-five, thirty-six,thirty-seven, thirty-eight, thirty-nine, forty, forty-one, forty-two,forty-three, forty-four, forty-five, forty-six, forty-seven,forty-eight, forty-nine, fifty, fifty-five, sixty, sixty-five, seventy,seventy-five, eighty, eighty-five, ninety, ninety-five, or one-hundredweek(s). In some embodiments, the frequency at which an antibody (e.g.,monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein is administered to a subject is less than one, two, three, four,five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen,or fifteen dose(s) per week.

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)is administered to a subject is, is at least, is less than, or is atmost about one, two, three, four, five, six, seven, eight, nine, ten,eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen,eighteen, nineteen, or twenty time(s) per every month, every two months,every three months, every four months, every five months, every sixmonths, every seven months, every eight months, every nine months, everyten months, every eleven months, every twelve months, every thirteenmonths, every fourteen months, every fifteen months, every sixteenmonths, every seventeen months, or every eighteen month(s). In someembodiments, the frequency at which a dose or amount of an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) isadministered to a subject is about one time per every one month. In someembodiments, the frequency at which a dose or amount of an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) isadministered to a subject is about one time per every three months. Insome embodiments, the frequency at which an antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein isadministered to a subject is less than about one, two, three, four,five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen,or fifteen dose(s) per month. In some embodiments, a dose or amount ofan antibody may be administered (e.g., subcutaneously or intravenouslyin an infusion) to a subject one time, two times, three times, fourtimes, five times, six times, seven times, eight times, nine times, tentimes or more per month.

In some embodiments, an antibody in a dose or amount of about 50 mg, 100mg 150 mg, 200 mg, 225 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500mg, 550 mg, 600 mg, 650 mg, 675 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500mg, 2550 mg, 2600 mg, 2650 mg, 2700 mg, 2750 mg, 2800 mg, 2850 mg, 2900mg, 2950 mg, 3000 mg, or more may be administered (e.g., subcutaneouslyor intravenously in an infusion) to a subject once per month. In someembodiments, an antibody in a dose or amount of between about 0.1 mg to5000 mg, 1 mg to 4000 mg, 10 mg to 3000 mg, 10 mg to 2000 mg, 100 mg to2000 mg, 150 mg to 2000 mg, 200 mg to 2000 mg, 250 mg to 2000 mg, 300 mgto 2000 mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450 mg to 2000 mg, 500mg to 2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg, 650 mg to 2000 mg,700 mg to 2000 mg, 750 mg to 2000 mg, 800 mg to 2000 mg, 850 mg to 2000mg, 900 mg to 2000 mg, 950 mg to 2000 mg, or about 1000 mg to 2000 mgmay be administered (e.g., subcutaneously or intravenously in aninfusion) to a subject once per month. In some embodiments, betweenabout 225 mg and about 1000 mg, e.g., about 225 mg of antibody areadministered once per month. An exemplary dosing regimen comprisesadministering an initial antibody dose of about 675 mg subcutaneously,followed by a monthly antibody dose of about 225 mg subcutaneously for,e.g., about two months, three months, four months, five months, sixmonths, seven months, eight months, nine months, ten months, 11 months,or 12 months, or even a period of greater than one year (e.g., 18months, two years, or three years). However, other dosage regimens maybe useful, depending on the pattern of pharmacokinetic decay that thepractitioner wishes to achieve.

In some embodiments, an antibody in a dose or amount of about 50 mg, 100mg 150 mg, 200 mg, 225 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500mg, 550 mg, 600 mg, 650 mg, 675 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500mg, 2550 mg, 2600 mg, 2650 mg, 2700 mg, 2750 mg, 2800 mg, 2850 mg, 2900mg, 2950 mg, 3000 mg, or more may be administered (e.g., subcutaneouslyor intravenously in an infusion) to a subject every three months. Insome embodiments, an antibody in a dose or amount of between about 0.1mg to 5000 mg, 1 mg to 4000 mg, 10 mg to 3000 mg, 10 mg to 2000 mg, 100mg to 2000 mg, 150 mg to 2000 mg, 200 mg to 2000 mg, 250 mg to 2000 mg,300 mg to 2000 mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450 mg to 2000mg, 500 mg to 2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg, 650 mg to2000 mg, 700 mg to 2000 mg, 750 mg to 2000 mg, 800 mg to 2000 mg, 850 mgto 2000 mg, 900 mg to 2000 mg, 950 mg to 2000 mg, or 1000 mg to 2000 mgmay be administered (e.g., subcutaneously or intravenously in aninfusion) to a subject every three months. In some embodiments, betweenabout 225 mg to about 1000 mg is administered once every three months orless, e.g., about 675 mg is administered subcutaneously about everythree months or about 900 mg is administered about every three monthsintravenously in an infusion. An exemplary dosing regimen comprisesadministering an initial or starting dose of about 900 mg intravenouslyin an infusion over about 60 minutes, followed by doses of about 900 mgadministered intravenously in an infusion over about 60 minutes everythree months for one year, two years, three years, four years, or fiveyears. Another exemplary dosing regimen comprises administering aninitial or starting dose of about 675 mg administered subcutaneously,followed by doses of about 675 mg administered subcutaneously everythree months for about one year, two years, three years, four years, orfive years. However, other dosage regimens may be useful, depending onthe pattern of pharmacokinetic decay that the practitioner wishes toachieve.

In some embodiments, an antibody in a dose or amount of about 50 mg, 100mg 150 mg, 200 mg, 225 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500mg, 550 mg, 600 mg, 650 mg, 675 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500mg, 2550 mg, 2600 mg, 2650 mg, 2700 mg, 2750 mg, 2800 mg, 2850 mg, 2900mg, 2950 mg, 3000 mg, or more may be administered (e.g., subcutaneouslyor intravenously in an infusion) to a subject every six months. In someembodiments, an antibody in a dose or amount of between about 0.1 mg to5000 mg, 1 mg to 4000 mg, 10 mg to 3000 mg, 10 mg to 2000 mg, 100 mg to2000 mg, 150 mg to 2000 mg, 200 mg to 2000 mg, 250 mg to 2000 mg, 300 mgto 2000 mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450 mg to 2000 mg, 500mg to 2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg, 650 mg to 2000 mg,700 mg to 2000 mg, 750 mg to 2000 mg, 800 mg to 2000 mg, 850 mg to 2000mg, 900 mg to 2000 mg, 950 mg to 2000 mg, or 1000 mg to 2000 mg may beadministered (e.g., subcutaneously or intravenously in an infusion) to asubject every six months. In some embodiments, between 225 mg to 1000 mgis administered once every six months or less. However, other dosageregimens may be useful, depending on the pattern of pharmacokineticdecay that the practitioner wishes to achieve.

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)is administered to a subject (e.g., subcutaneously or intravenously) is,is at least, is less than, or is at most one, two, three, four, five,six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen,fifteen, sixteen, seventeen, eighteen, nineteen, or twenty time(s) perevery quarter. As can be appreciated, a “quarter” can refer to a timeperiod of a quarter year or may also refer to a calendar quarter such asa time period of January 1-March 31, April 1-June 30, July 1-September30, or October 1-December 31. In some cases, a “quarter” may refer to atime period of approximately three months.

In some embodiments, an antibody in a dose or amount of about 50 mg, 100mg 150 mg, 200 mg, 225 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500mg, 550 mg, 600 mg, 650 mg, 675 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500mg, 2550 mg, 2600 mg, 2650 mg, 2700 mg, 2750 mg, 2800 mg, 2850 mg, 2900mg, 2950 mg, 3000 mg, or more may be administered (e.g., subcutaneouslyor intravenously in an infusion) to a subject every quarter. In someembodiments, an antibody in a dose or amount of between about 0.1 mg to5000 mg, 1 mg to 4000 mg, 10 mg to 3000 mg, 10 mg to 2000 mg, 100 mg to2000 mg, 150 mg to 2000 mg, 200 mg to 2000 mg, 250 mg to 2000 mg, 300 mgto 2000 mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450 mg to 2000 mg, 500mg to 2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg, 650 mg to 2000 mg,700 mg to 2000 mg, 750 mg to 2000 mg, 800 mg to 2000 mg, 850 mg to 2000mg, 900 mg to 2000 mg, 950 mg to 2000 mg, or 1000 mg to 2000 mg may beadministered (e.g., subcutaneously or intravenously in an infusion) to asubject every quarter. An exemplary dosing regimen comprisesadministering an initial or starting dose of about 900 mg intravenouslyin an infusion over about 60 minutes, followed by doses of about 900 mgadministered intravenously in an infusion over about 60 minutes everyquarter for one year, two years, three years, four years, or five years.Another exemplary dosing regimen comprises administering an initial orstarting dose of about 675 mg administered subcutaneously, followed bydoses of about 675 mg administered subcutaneously every quarter forabout one year, two years, three years, four years, or five years.However, other dosage regimens may be useful, depending on the patternof pharmacokinetic decay that the practitioner wishes to achieve.

In some embodiments, the frequency at which a dose or amount of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)is administered is, is at least, is less than, or is at most about one,two, three, four, five, six, seven, eight, nine, ten, eleven, twelve,thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, ortwenty time(s) per every year, every two years, every three years, everyfour years, or every five years. In some embodiments, the frequency atwhich an antibody (e.g., monoclonal antibody that modulates the CGRPpathway, anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonistantibody) is administered to a subject is less than one, two, three,four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen,fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty,twenty-one, twenty-two, twenty-three, twenty-four or twenty-five dose(s)per year.

In some embodiments, an antibody in a dose or amount of about 50 mg, 100mg 150 mg, 200 mg, 225 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500mg, 550 mg, 600 mg, 650 mg, 675 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500mg, 2550 mg, 2600 mg, 2650 mg, 2700 mg, 2750 mg, 2800 mg, 2850 mg, 2900mg, 2950 mg, 3000 mg, or more may be administered to a subject once peryear. In some embodiments, an antibody in a dose or amount of betweenabout 0.1 mg to 5000 mg, 1 mg to 4000 mg, 10 mg to 3000 mg, 10 mg to2000 mg, 100 mg to 2000 mg, 150 mg to 2000 mg, 200 mg to 2000 mg, 250 mgto 2000 mg, 300 mg to 2000 mg, 350 mg to 2000 mg, 400 mg to 2000 mg, 450mg to 2000 mg, 500 mg to 2000 mg, 550 mg to 2000 mg, 600 mg to 2000 mg,650 mg to 2000 mg, 700 mg to 2000 mg, 750 mg to 2000 mg, 800 mg to 2000mg, 850 mg to 2000 mg, 900 mg to 2000 mg, 950 mg to 2000 mg, or 1000 mgto 2000 mg may be administered to a subject every once per year. In someembodiments, between about 450 mg and about 2000 mg is administered onceevery year or less.

In some embodiments, a method may comprise administering an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein to a subject on a plurality of days. Two, three, four, five, six,seven, eight or more days of the plurality of days may be more than 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75or more days apart. In some embodiments, two of the plurality of daysare more than one, two, three, four, five, six, seven, eight, nine, ten,eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen,eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three,twenty-four, twenty-five, twenty-six, twenty-seven, twenty-eight,twenty-nine, thirty or more days apart. Moreover, in some embodiments,the amount of antibody administered on a first day of the plurality ofdays may be different (e.g., higher or lower) than the amount of theantibody administered on a second day.

In some embodiments, an initial dose (which can also be referred to as aloading dose or a starting dose) of an antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein may beadministered to a subject, followed by administration of one or moreadditional doses at desired intervals. In some embodiments, the initialdose (or starting dose) and one or more of the additional doses are thesame dose. In some embodiments, the one or more additional doses are adifferent dose than the initial or starting dose. In some embodiments,the initial dose and one or more of the additional doses areadministered the same way, i.e., subcutaneously or intravenously. Insome embodiments, the one or more additional doses are administered in adifferent way than the initial dose, e.g., the initial dose may beadministered intravenously and the one or more additional doses may beadministered subcutaneously. In some embodiments, the frequency at whichthe one or more additional doses are administered is constant (e.g.,every month or every three months). In some embodiments, the frequencyat which the one or more additional doses are administered is variable(e.g., one additional dose administered at one month following theinitial dose, followed by another additional dose at three monthsfollowing the initial dose). Any desirable and/or therapeutic regimen ofinitial loading dose, additional doses, and frequency (e.g., includingthose described herein) of additional doses may be used. An exemplaryregimen includes an initial loading dose of about 225 mg anti CGRPantagonist antibody administered subcutaneously, followed by subsequentmaintenance doses of about 225 mg of the antibody administeredsubcutaneously at one month intervals. An exemplary regimen includes aninitial loading dose of about 675 mg anti-CGRP antagonist antibodyadministered subcutaneously, followed by subsequent maintenance doses ofabout 225 mg of the antibody administered subcutaneously at one monthintervals. Yet another exemplary regimen includes an initial dose ofabout 900 mg anti-CGRP antagonist antibody administered intravenously inan infusion over about 60 minutes, followed by subsequent maintenancedoses of about 900 mg anti-CGRP antagonist antibody administeredintravenously in an infusion over about 60 minutes at three monthintervals. Another exemplary regimen comprises an initial or startingdose of about 675 mg anti-CGRP antagonist antibody administeredsubcutaneously, followed by subsequent maintenance doses of about 675 mganti CGRP antagonist antibody administered subcutaneously at three monthintervals.

In some embodiments, an initial dose (or starting dose) of an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) of about0.1 μg, 1 μg, 100 μg, 1 mg, 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg,150 mg, 175 mg, 200 mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg,375 mg, 400 mg, 450 mg, 475 mg, 500 mg, 525 mg, 550 mg, 575 mg, 600 mg,625 mg, 650 mg, 675 mg, 700 mg, 725 mg, 750 mg, 775 mg, 800 mg, 825 mg,850 mg, 875 mg, 900 mg, 925 mg, 950 mg, 975 mg, 1000 mg, 1500 mg, 2000mg, or about 3000 mg may be administered to a subject followed by one ormore additional doses of the antibody of about 0.1 μg, 1 μg, 100 μg, 1mg, 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg, 175 mg, 200 mg,225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 450 mg,475 mg, 500 mg, 525 mg, 550 mg, 575 mg, 600 mg, 625 mg, 650 mg, 675 mg,700 mg, 725 mg, 750 mg, 775 mg, 800 mg, 825 mg, 850 mg, 875 mg, 900 mg,925 mg, 950 mg, 975 mg, 1000 mg, 1500 mg, 2000 mg, or about 3000 mg. Anexemplary regimen includes an initial loading dose of about 225 mg antiCGRP antagonist antibody administered subcutaneously, followed bysubsequent maintenance doses of about 225 mg of the antibodyadministered subcutaneously at one month intervals. An exemplary regimenincludes an initial loading dose of about 675 mg anti-CGRP antagonistantibody administered subcutaneously, followed by subsequent maintenancedoses of about 225 mg of the antibody administered subcutaneously at onemonth intervals. Yet another exemplary regimen includes an initial doseof about 900 mg anti-CGRP antagonist antibody administered intravenouslyin an infusion over about 60 minutes, followed by subsequent maintenancedoses of about 900 mg anti-CGRP antagonist antibody administeredintravenously in an infusion over about 60 minutes at three monthintervals. Another exemplary regimen comprises an initial or startingdose of about 675 mg anti-CGRP antagonist antibody administeredsubcutaneously, followed by subsequent maintenance doses of about 675 mganti-CGRP antagonist antibody administered subcutaneously at three monthintervals.

In some embodiments, a dose or amount of antibody (e.g., monoclonalantibody that modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein may bedivided into sub-doses and administered as multiple sub-doses,depending, for example, on the route of administration and/or particularformulation administered. For example, in cases where a dose isadministered subcutaneously, the subcutaneous dose may be divided intomultiple sub-doses and each sub-dose administered at a different site inorder to avoid, for example, a larger, single subcutaneous injection ata single site. For example, an intravenous dose of 900 mg may be dividedinto four sub-doses of 225 mg each. As another example, a subcutaneousdose of 675 mg may be divided into three sub-doses of 225 mg each andeach 225 mg dose may be administered at a different site, which can helpminimize the volume injected at each site. The division of sub-doses maybe equal (e.g., three equal sub-doses) or may be unequal (e.g., threesub-doses, two of the sub-doses twice as large as the other sub-doses).

In some embodiments, the number of doses of antibody administered to asubject over the course of treatment may vary depending upon, forexample, achieving reduced incidence of a refractory migraine and/orsecondary symptom associated with a refractory migraine in the subject.For example, the number of doses administered over the course oftreatment may be, may be at least, or may be at most 1, 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25,26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43,44, 45, 46, 47, 48, 49, 50, or treatment may be given indefinitely. Insome cases, treatment may be acute such that at most 1, 2, 3, 4, 5, or 6doses are administered to a subject for treatment.

In some embodiments, a dose (or sub-dose) or amount of an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein may be formulated in a liquid formulation and administered (e.g.,via subcutaneous injection, via intravenous injection) to a subject. Insuch cases, the volume of liquid formulation comprising antibody mayvary depending upon, for example, the concentration of antibody in theliquid formulation, the desired dose of antibody, and/or the route ofadministration used. For example, the volume of liquid formulationcomprising an antibody described herein and administered (e.g., via aninjection, such as, for example, a subcutaneous injection or anintravenous infusion) to a subject may be from about 0.001 mL to about10.0 mL, about 0.01 mL to about 5.0 mL, about 0.1 mL to about 5 mL,about 0.1 mL to about 3 mL, about 0.5 mL to about 2.5 mL, or about 1 mLto about 2.5 mL. For example, the volume of liquid formulationcomprising an antibody (e.g., monoclonal antibody that modulates theCGRP pathway, anti-CGRP antagonist antibody, monoclonal anti-CGRPantagonist antibody) described herein and administered (e.g., via aninjection, such as, for example, a subcutaneous injection, or anintravenous infusion) to a subject may be, may be at least, may be lessthan, or may be at most about 0.001, 0.005, 0.01, 0.02, 0.03, 0.04,0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8,0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3,2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7,3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 5.0, 5.5,6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, or about 10.0 mL.

In some embodiments, a dose (or sub-dose) or amount of an antibody(e.g., monoclonal antibody that modulates the CGRP pathway, anti-CGRPantagonist antibody, monoclonal anti-CGRP antagonist antibody) describedherein may be supplied in prefilled receptacles useful in administeringantibody to a subject. Such prefilled receptacles may be designed forself-administration or for administration by another. For example, adose (or sub-dose) or amount of antibody described herein may besupplied as a liquid formulation in pre-filled syringes, pre-filledsyringes with a needle safety device, injection pens, or auto-injectors.In such examples, the pre-filled syringes may be designed forself-administration or for administration by another. In some cases, thepre-filled syringes or auto-injectors may be designed for subcutaneousadministration and/or intravenous administration.

For the purpose of the present invention, the appropriate dosage of anantibody may depend on the antibody (or compositions thereof) employed,the type and severity of the secondary symptom, the type and severity ofthe refractory migraine or other condition to be treated, whether theagent is administered for preventive or therapeutic purposes, previoustherapy, the patient's clinical history and response to the agent, andthe discretion of the attending physician. Typically, the clinician willadminister an antibody, until a dosage is reached that achieves thedesired result. Dose and/or frequency can vary over course of treatment.

Empirical considerations, such as the half-life, generally willcontribute to the determination of the dosage. For example, antibodiesthat are compatible with the human immune system, such as humanizedantibodies or fully human antibodies, may be used to prolong half-lifeof the antibody and to prevent the antibody being attacked by the host'simmune system. Frequency of administration may be determined andadjusted over the course of therapy, and is generally, but notnecessarily, based on treatment and/or suppression and/or ameliorationand/or delay of refractory migraine or other condition. Alternatively,sustained continuous release formulations of antibodies may beappropriate. Various formulations and devices for achieving sustainedrelease are known in the art.

In one embodiment, dosages for an antibody (e.g., monoclonal antibodythat modulates the CGRP pathway, anti-CGRP antagonist antibody,monoclonal anti-CGRP antagonist antibody) described herein may bedetermined empirically in individuals who have been given one or moreadministration(s) of the antibody. Individuals are given incrementaldosages of an antibody. To assess efficacy of an antibody, an indicatorof the disease can be followed.

Administration of an antibody (e.g., monoclonal antibody that modulatesthe CGRP pathway, anti-CGRP antagonist antibody, monoclonal anti-CGRPantagonist antibody) in accordance with the methods of the presentinvention can be continuous or intermittent, depending, for example,upon the recipient's physiological condition, whether the purpose of theadministration is therapeutic or prophylactic, and other factors knownto skilled practitioners. The administration of an antibody may beessentially continuous over a preselected period of time or may be in aseries of spaced dose, e.g., either before, during, or after developingrefractory migraine; before; during; before and after; during and after;before and during; or before, during, and after developing refractorymigraine. Administration can be before, during and/or after any eventlikely to give rise to refractory migraine.

In some embodiments, more than one antibody may be present. At leastone, at least two, at least three, at least four, at least fivedifferent, or more antibodies can be present. Generally, thoseantibodies may have complementary activities that do not adverselyaffect each other. An antibody (e.g., monoclonal antibody that modulatesthe CGRP pathway, anti-CGRP antagonist antibody, monoclonal anti-CGRPantagonist antibody) described herein can also be used in conjunctionwith other CGRP antagonists or CGRP receptor antagonists. For example,one or more of the following CGRP antagonists may be used: an anti-sensemolecule directed to a CGRP (including an anti-sense molecule directedto a nucleic acid encoding CGRP), a CGRP inhibitory compound, a CGRPstructural analog, a dominant-negative mutation of a CGRP receptor thatbinds a CGRP, and an anti-CGRP receptor antibody. An antibody can alsobe used in conjunction with other agents that serve to enhance and/orcomplement the effectiveness of the agents.

Diagnosis or assessment of refractory migraine is well-established inthe art. Assessment may be performed based on subjective measures, suchas patient characterization of symptoms and medical history documentinginadequate response to prior preventative treatments. In someembodiments, assessment of refractory migraine may be via headachehours, as described elsewhere herein. For example, assessment ofrefractory migraine may be in terms of daily headache hours, weeklyheadache hours, monthly headache hours and/or yearly headache hours. Insome cases, headache hours may be as reported by the subject.

Treatment efficacy can be assessed by methods well-known in the art. Forexample, pain relief may be assessed. Accordingly, in some embodiments,pain relief is subjectively observed after 1, 2, or a few hours afteradministering an anti-CGRP antibody. In some embodiments, frequency ofrefractory migraine attacks is subjectively observed after administeringan anti-CGRP antibody.

In some embodiments, a method for preventing, treating, or reducingincidence of migraine in a subject having refractory migraine asdescribed herein may reduce incidence of migraine after a singleadministration of an antibody (e.g., monoclonal antibody that modulatesthe CGRP pathway, anti-CGRP antagonist antibody, monoclonal anti-CGRPantagonist antibody) described herein for an extended period of time.For example, incidence of migraine may be reduced for at least 0.5, 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or more days after a singleadministration.

In some embodiments, a method for treating or reducing incidence ofmigraine in a subject as described herein (i.e., having refractorymigraine) may reduce the number of headache hours experienced by asubject from a pre-administration level after administration of one ormore doses of an antibody (e.g., monoclonal antibody that modulates theCGRP pathway, anti-CGRP antagonist antibody, monoclonal anti-CGRPantagonist antibody) described herein to the subject. For example, dailyheadache hours experienced by the subject after administering one ormore doses of an antibody to the subject may be reduced by 0.5, 1, 2, 3,4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,23, or 24 headache hours from a pre-administration level in the subject.In some cases, daily headache hours experienced by the subject afteradministering one or more doses of an antibody to the subject may bereduced by 0.5%, 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or more relative to apre-administration level in the subject. In another example, weeklyheadache hours experienced by the subject after administering one ormore doses of an antibody to the subject may be reduced by 0.5, 1, 5,10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 or more headachehours from a pre-administration level in the subject. In some cases,weekly headache hours experienced by the subject after administering oneor more doses of an antibody to the subject may be reduced by 0.5%, 1%,5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%,75%, 80%, 85%, 90%, 95%, 99%, or more relative to a pre-administrationlevel in the subject. In another example, monthly headache hoursexperienced by the subject after administering one or more doses of anantibody to the subject may be reduced by 0.5, 1, 5, 10, 15, 20, 25, 30,35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115,120, 125, or more headache hours from a pre-administration level. Insome cases, monthlyheadache hours experienced by the subject afteradministering one or more doses of an antibody to the subject may bereduced by 0.5%, 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99% or more relative to apre-administration level in the subject.

In some embodiments, a method for treating or reducing incidence ofmigraine in a subject having refractory migraine as described herein mayreduce the number of headache days experienced by a subject from apre-administration level after administration of one or more doses of anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonist antibody)described herein to the subject. For example, weekly headache daysexperienced by the subject after administering one or more doses of anantibody to the subject may be reduced by 0.5, 1, 1.5, 2, 2.5, 3, 3.5,4, 4.5, 5, 5.5, 6, 6.5, or 7 headache days from a pre-administrationlevel in the subject. In some cases, weekly headache days experienced bythe subject after administering one or more doses of an antibody to thesubject may be reduced by 0.5%, 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%,40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99% or morerelative to a pre-administration level in the subject. In anotherexample, monthly headache days experienced by the subject afteradministering one or more doses of an antibody to the subject may bereduced by 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20 or more headachedays from a pre-administration level.

In some embodiments, a method may comprise administering to a subjectone or more additional agent(s) simultaneously or sequentially with anantibody (e.g., monoclonal antibody that modulates the CGRP pathway,anti-CGRP antagonist antibody, monoclonal anti-CGRP antagonistantibody). In some embodiments, an additional agent may be an acuteheadache medication such as 5-HT1 agonists, triptans, ergot alkaloids,opiates, and NSAIDs) described elsewhere herein. In some embodiments, atherapeutic effect may be greater as compared to use of an antibody orone or more additional agent(s) alone. Accordingly, a synergistic effectbetween an antibody and the one or more additional agents may beachieved.

B. Anti-CGRP Antagonist Antibodies

In some embodiments, the methods of the invention use an antibody, whichcan be an anti-CGRP antagonist antibody. An anti-CGRP antagonistantibody can refer to any antibody molecule that blocks, suppresses orreduces (including significantly) CGRP biological activity, includingdownstream pathways mediated by CGRP signaling, such as receptor bindingand/or elicitation of a cellular response to CGRP.

An anti-CGRP antagonist antibody can exhibit any one or more of thefollowing characteristics: (a) bind to CGRP; (b) block CGRP from bindingto its receptor(s); (c) block or decrease CGRP receptor activation(including, but not limited to, cAMP activation); (d) inhibit CGRPbiological activity or downstream pathways mediated by CGRP signalingfunction; (e) prevent, ameliorate, or treat any aspect of refractorymigraine; (f) increase clearance of CGRP; and (g) inhibit (reduce) CGRPsynthesis, production or release. Anti-CGRP antagonist antibodies areknown in the art. See e.g., Tan et al., Clin. Sci. (Lond). 89:565-73,1995; Sigma (Missouri, US), product number C7113 (clone #4901); Plourdeet al., Peptides 14:1225-1229, 1993.

In some embodiments, the antibody reacts with CGRP in a manner thatinhibits CGRP, and/or the CGRP pathway, including downstream pathwaysmediated by the CGRP signaling function. In some embodiments, theanti-CGRP antagonist antibody recognizes human CGRP. In someembodiments, the anti-CGRP antagonist antibody binds to both humanα-CGRP and β-CGRP. In some embodiments, the anti-CGRP antagonistantibody binds human and rat CGRP. In some embodiments, the anti-CGRPantagonist antibody binds the C-terminal fragment having amino acids25-37 of CGRP. In some embodiments, the anti-CGRP antagonist antibodybinds a C-terminal epitope within amino acids 25-37 of CGRP.

The antibodies useful in the present invention can encompass monoclonalantibodies, polyclonal antibodies, antibody fragments (e.g., Fab, Fab′,F(ab′)2, Fv, Fc, etc.), chimeric antibodies, bispecific antibodies,heteroconjugate antibodies, single chain (ScFv), mutants thereof, fusionproteins comprising an antibody portion (e.g., a domain antibody),humanized antibodies, and any other modified configuration of theimmunoglobulin molecule that comprises an antigen recognition site ofthe required specificity, including glycosylation variants ofantibodies, amino acid sequence variants of antibodies, and covalentlymodified antibodies. The antibodies may be murine, rat, human, or anyother origin (including chimeric or humanized antibodies).

In some embodiments, the anti-CGRP antagonist antibody is a monoclonalantibody. In some embodiments, the anti-CGRP antagonist antibody ishumanized. In some embodiments, the antibody is human. In someembodiments, the anti-CGRP antagonist antibody is antibody G1 (asdescribed herein). In some embodiments, the anti-CGRP antagonistantibody comprises one or more CDR(s) (such as one, two, three, four,five, or, in some embodiments, all six CDRs) of antibody G1 or variantsof G1 shown in Table 6. In still other embodiments, the anti-CGRPantagonist antibody comprises the amino acid sequence of the heavy chainvariable region shown in FIG. 5 (SEQ ID NO:1) and the amino acidsequence of the light chain variable region shown in FIG. 5 (SEQ IDNO:2). In still other embodiments, the anti-CGRP antagonist antibodycomprises a heavy chain full antibody amino acid sequence shown in SEQID NO:11 and a light chain full antibody amino acid sequence shown inSEQ ID NO:12.

In some embodiments, the antibody comprises a light chain variableregion (LCVR) and a heavy chain variable region (HCVR) selected from thegroups consisting of: (a) LCVR17 (SEQ ID NO:58) and HCVR22 (SEQ IDNO:59); (b) LCVR18 (SEQ ID NO:60) and HCVR23 (SEQ ID NO:61); (c) LCVR19(SEQ ID NO:62) and HCVR24 (SEQ ID NO:63); (d) LCVR20 (SEQ ID NO:64) andHCVR25 (SEQ ID NO:65); (e) LCVR21 (SEQ ID NO:66) and HCVR26 (SEQ IDNO:67); (f) LCVR27 (SEQ ID NO:68) and HCVR28 (SEQ ID NO:69); (g) LCVR29(SEQ ID NO:70) and HCVR30 (SEQ ID NO:71); (h) LCVR31 (SEQ ID NO:72) andHCVR32 (SEQ ID NO:73); (i) LCVR33 (SEQ ID NO:74) and HCVR34 (SEQ IDNO:75); (j) LCVR35 (SEQ ID NO:76) and HCVR36 (SEQ ID NO:77); and (k)LCVR37 (SEQ ID NO:78) and HCVR38 (SEQ ID NO:79). Sequences of theseregions are provided herein. Other examples of anti-CGRP antibodies aredescribed in US20110305711 (SEQ ID NOs:5, 6, 7, 12, 16, 19, 24, 29, 34,and 39), US20120294802, US20120294797 (SEQ ID NOs:51-60), which arehereby incorporated by reference in their entireties. For example,antibodies with any of the following sequences may be used.

Ab6 Variable region Light chain (humanized) protein sequence(US20120294797) (SEQ ID NO: 80)QVLTQSPSSLSASVGDRVTINCQASQSVYHNTYLAWYQQKPGKVPKQLIYDASTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCTNGDCFVFGGGTKVEIKRAb6 Light chain (humanized) Full length protein sequence (US20120294797)(SEQ ID NO: 81)QVLTQSPSSLSASVGDRVTINCQASQSVYHNTYLAWYQQKPGKVPKQLIYDASTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCTNGDCFVFGGGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGECAb6 Variable region heavy chain (humanized) protein sequence(US20120294797) (SEQ ID NO: 82)EVQLVESGGGLVQPGGSLRLSCAVSGIDLSGYYMNWVRQAPGKGLEWVGVIGINGATYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSAb6 Heavy chain (humanized) Full length protein sequence -yeast produced (US20120294797) (SEQ ID NO: 83)EVQLVESGGGLVQPGGSLRLSCAVSGIDLSGYYMNWVRQAPGKGLEWVGVIGINGATYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDARVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYASTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGKAb6 Variable region Light chain (humanized) protein sequence CDRI(US20120294797) (SEQ ID NO: 84) QASQSVYHNTYLAAb6 Variable region Light chain (humanized) protein sequence CDR2(US20120294797) (SEQ ID NO: 85) DASTLASAb6 Variable region Light chain (humanized) protein sequence CDR3(US20120294797) (SEQ ID NO: 86) LGSYDCTNGDCFVAb6 Variable region heavy chain (humanized) protein sequence CDRI(US20120294797) (SEQ ID NO: 87) GYYMNAb6 Variable region heavy chain (humanized) protein sequence CDR2(US20120294797) (SEQ ID NO: 88) IGINGATYYASWAKGAb6 Variable region heavy chain (humanized) protein sequence CDR3(US20120294797) (SEQ ID NO: 89) GDILight chain variable region protein sequence CDR3 (US20110305711)(SEQ ID NO: 90) QQGDALPPTLight chain variable region protein sequence CDR1 (US20110305711)(SEQ ID NO: 91) RASKDISKYLLight chain variable region protein sequence CDR2 (US20110305711)(SEQ ID NO: 92) YTSGYSHHeavy chain variable region protein sequence CDR1 (US20110305711)(SEQ ID NO: 93) GYTFGNYWMQHeavy chain variable region protein sequence CDR2 (US20110305711)(SEQ ID NO: 94) AIYEGTGKTVYIQKFADHeavy chain variable region protein sequence CDR3 (US20110305711)(SEQ ID NO: 95) LSDYVSGFGYLight chain variable region protein sequence (US20110305711)(SEQ ID NO: 96)DIQMTQSPSSLSASVGDRVTITCRASKDISKYLNWYQQKPGKAPKLLIYYTSGYHSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQGDALPPTFGGGTKVEIKHeavy chain variable region protein sequence (US20110305711)(SEQ ID NO: 97) QVQLVQSGAEVKKPGSSVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFADRVTITADKSTSTAYMELSSLRSEDTAVYYCARLSDYVSGFGYWGQGT TVTVSSLight chain protein sequence (US20110305711) (SEQ ID NO: 98)DIQMTQSPSSLSASVGDRVTITCRASKDISKYLNWYQQKPGKAPKLLIYYTSGYHSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQGDALPPTFGGGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGECHeavy chain protein sequence (US20110305711) (SEQ ID NO: 99)QVQLVQSGAEVKKPGSSVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFADRVTITADKSTSTAYMELSSLRSEDTAVYYCARLSDYVSGFGYWGQGTTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYTCNVDHKPSNTKVDKRVESKYGPPCPPCPAPEAAGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLG

In some embodiments, the antibody comprises a modified constant region,such as a constant region that is immunologically inert describedherein. In some embodiments, the constant region is modified asdescribed in Eur. J. Immunol. (1999) 29:2613-2624; PCT Application No.PCT/GB99/01441; and/or UK Patent Application No. 9809951.8. In otherembodiments, the antibody comprises a human heavy chain IgG2 constantregion comprising the following mutations: A330P331 to S330S331 (aminoacid numbering with reference to the wildtype IgG2 sequence). Eur. J.Immunol. (1999) 29:2613-2624. In some embodiments, the antibodycomprises a constant region of IgG4 comprising the following mutations:E233F234L235 to P233V234A235. In still other embodiments, the constantregion is aglycosylated for N-linked glycosylation. In some embodiments,the constant region is aglycosylated for N-linked glycosylation bymutating the oligosaccharide attachment residue (such as Asn297) and/orflanking residues that are part of the N-glycosylation recognitionsequence in the constant region. In some embodiments, the constantregion is aglycosylated for N-linked glycosylation. The constant regionmay be aglycosylated for N-linked glycosylation enzymatically or byexpression in a glycosylation deficient host cell.

The binding affinity (K_(D)) of an anti-CGRP antagonist antibody to CGRP(such as human α-CGRP) can be about 0.02 to about 200 nM. In someembodiments, the binding affinity is any of about 200 nM, about 100 nM,about 50 nM, about 10 nM, about 1 nM, about 500 pM, about 100 pM, about60 pM, about 50 pM, about 20 pM, about 15 pM, about 10 pM, about 5 pM,or about 2 pM. In some embodiments, the binding affinity is less thanany of about 250 nM, about 200 nM, about 100 nM, about 50 nM, about 10nM, about 1 nM, about 500 pM, about 100 pM, or about 50 pM.

One way of determining binding affinity of antibodies to CGRP is bymeasuring binding affinity of monofunctional Fab fragments of theantibody. To obtain monofunctional Fab fragments, an antibody (forexample, IgG) can be cleaved with papain or expressed recombinantly. Theaffinity of an anti-CGRP Fab fragment of an antibody can be determinedby surface plasmon resonance (Biacore3000™ surface plasmon resonance(SPR) system, Biacore, INC, Piscataway N.J.) equipped withpre-immobilized streptavidin sensor chips (SA) using HBS-EP runningbuffer (0.01M HEPES, pH 7.4, 0.15 NaCl, 3 mM EDTA, 0.005% v/v SurfactantP20). Biotinylated human CGRP (or any other CGRP) can be diluted intoHBS-EP buffer to a concentration of less than 0.5 pg/mL and injectedacross the individual chip channels using variable contact times, toachieve two ranges of antigen density, either 50-200 response units (RU)for detailed kinetic studies or 800-1,000 RU for screening assays.Regeneration studies have shown that 25 mM NaOH in 25% v/v ethanoleffectively removes the bound Fab while keeping the activity of CGRP onthe chip for over 200 injections. Typically, serial dilutions (spanningconcentrations of 0.1-10× estimated K_(D)) of purified Fab samples areinjected for 1 min at 100 μL/minute and dissociation times of up to 2hours are allowed. The concentrations of the Fab proteins are determinedby ELISA and/or SDS-PAGE electrophoresis using a Fab of knownconcentration (as determined by amino acid analysis) as a standard.Kinetic association rates (k_(on)) and dissociation rates (k_(off)) areobtained simultaneously by fitting the data globally to a 1:1 Langmuirbinding model (Karlsson, R. Roos, H. Fagerstam, L. Petersson, B. (1994).Methods Enzymology 6. 99-110) using the BIAevaluation program.Equilibrium dissociation constant (K_(D)) values are calculated ask_(off)/k_(on). This protocol is suitable for use in determining bindingaffinity of an antibody to any CGRP, including human CGRP, CGRP ofanother mammalian (such as mouse CGRP, rat CGRP, primate CGRP), as wellas different forms of CGRP (such as a and β form). Binding affinity ofan antibody is generally measured at 25° C., but can also be measured at37° C.

Antibodies, including anti-CGRP antagonist antibodies, may be made byany method known in the art. The route and schedule of immunization ofthe host animal are generally in keeping with established andconventional techniques for antibody stimulation and production, asfurther described herein. General techniques for production of human andmouse antibodies are known in the art and are described herein.

It is contemplated that any mammalian subject including humans orantibody producing cells therefrom can be manipulated to serve as thebasis for production of mammalian, including human, hybridoma celllines. Typically, the host animal is inoculated intraperitoneally,intramuscularly, orally, subcutaneously, intraplantar, and/orintradermally with an amount of immunogen, including as describedherein.

Antibodies (e.g., anti-CGRP antagonist antibodies) and polypeptidesderived from antibodies can be identified or characterized using methodsknown in the art, whereby reduction, amelioration, or neutralization ofa CGRP biological activity is detected and/or measured. For example,anti-CGRP antagonist antibody can also be identified by incubating acandidate agent with CGRP and monitoring any one or more of thefollowing characteristics: (a) bind to CGRP; (b) block CGRP from bindingto its receptor(s); (c) block or decrease CGRP receptor activation(including cAMP activation); (d) inhibit CGRP biological activity ordownstream pathways mediated by CGRP signaling function; (e) prevent,ameliorate, or treat any aspect of refractory migraine; (f) increaseclearance of CGRP; and (g) inhibit (reduce) CGRP synthesis, productionor release. In some embodiments, an anti-CGRP antagonist antibody orpolypeptide is identified by incubating a candidate agent with CGRP andmonitoring binding and/or attendant reduction or neutralization of abiological activity of CGRP. The binding assay may be performed withpurified CGRP polypeptide(s), or with cells naturally expressing, ortransfected to express, CGRP polypeptide(s). In one embodiment, thebinding assay is a competitive binding assay, where the ability of acandidate antibody to compete with a known anti-CGRP antagonist for CGRPbinding is evaluated. The assay may be performed in various formats,including the ELISA format. In other embodiments, an anti-CGRPantagonist antibody is identified by incubating a candidate agent withCGRP and monitoring binding and attendant inhibition of CGRP receptoractivation expressed on the surface of a cell. In some embodiments, ananti-CGRP receptor antibody can be used in any of the methods describedherein. For example, anti-CGRP receptor antibodies, as described inUS20100172895 and U.S. Pat. No. 9,102,731, which are hereby incorporatedby reference in their entireties, may be used. Therefore, antibodieswith any of the following sequences may be used.

Light chain variable region protein sequence CDR1(U.S. Pat. No. 9,102,731) (SEQ ID NO: 100) SGSSSNIGNNYVSLight chain variable region protein sequence CDR2(U.S. Pat. No. 9,102,731) (SEQ ID NO: 101) DNNKRPSLight chain variable region protein sequence CDR3(U.S. Pat. No. 9,102,731) (SEQ ID NO: 102) GTWDSRLSAVVHeavy chain variable region protein sequence CDR1(U.S. Pat. No. 9,102,731) (SEQ ID NO: 103) SFGMHHeavy chain variable region protein sequence CDR2(U.S. Pat. No. 9,102,731) (SEQ ID NO: 104) VISFDGSIKYSVDSVKGHeavy chain variable region protein sequence CDR3(U.S. Pat. No. 9,102,731) (SEQ ID NO: 105) DRLNYYDSSGYYHYKYYGMAVLight chain variable region protein sequence (U.S. Pat. No. 9,102,731)(SEQ ID NO: 106) QSVLTQPPSVSAAPGQKVTISCSGSSSNIGNNYVSWYQQLPGTAPKLLIYDNNKRPSGIPDRFSGSKSGTSTTLGITGLQTGDEADYYCGTWDSRLSAVV FGGGTKLTVLHeavy chain variable region protein sequence (U.S. Pat. No. 9,102,731)(SEQ ID NO: 107) QVQLVESGGGVVQPGRSLRLSCAASGFTFSSFGMHWVRQAPGKGLEWVAVISFDGSIKYSVDSVKGRFTISRDNSKNTLFLQMNSLRAEDTAVYYCARDRLNYYDSSGYYHYKYYGMAVWGQGTTVTVSSLight chain protein sequence (U.S. Pat. No. 9,102,731) (SEQ ID NO: 108)MDMRVPAQLLGLLLLWLRGARCQSVLTQPPSVSAAPGQKVTISCSGSSSNIGNNYVSWYQQLPGTAPKLLIYDNNKRPSGIPDRFSGSKSGTSTTLGITGLQTGDEADYYCGTWDSRLSAVVFGGGTKLTVLGQPKANPTVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADGSPVKAGVETTKPSKQSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECSHeavy chain protein sequence (U.S. Pat. No. 9,102,731) (SEQ ID NO: 109)MDMRVPAQLLGLLLLWLRGARCQVQLVESGGGVVQPGRSLRLSCAASGFTFSSFGMHWVRQAPGKGLEWVAVISFDGSIKYSVDSVKGRFTISRDNSKNTLFLQMNSLRAEDTAVYYCARDRLNYYDSSGYYHYKYYGMAVWGQGTTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSNFGTQTYTCNVDHKPSNTKVDKTVERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLPAPIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK

Following initial identification, the activity of a candidate antibody(e.g., anti-CGRP antagonist antibody) can be further confirmed andrefined by bioassays, known to test the targeted biological activities.Alternatively, bioassays can be used to screen candidates directly. Someof the methods for identifying and characterizing anti-CGRP antagonistantibody or polypeptide are described in detail in the Examples.

Antibodies, including anti-CGRP antagonist antibodies, may becharacterized using methods well known in the art. For example, onemethod is to identify the epitope to which it binds, or “epitopemapping.” There are many methods known in the art for mapping andcharacterizing the location of epitopes on proteins, including solvingthe crystal structure of an antibody-antigen complex, competitionassays, gene fragment expression assays, and synthetic peptide-basedassays, as described, for example, in Chapter 11 of Harlow and Lane,Using Antibodies, a Laboratory Manual, Cold Spring Harbor LaboratoryPress, Cold Spring Harbor, N.Y., 1999.

Yet another method which can be used to characterize an antibody,including an anti-CGRP antagonist antibody, is to use competition assayswith other antibodies known to bind to the same antigen, i.e., variousfragments on CGRP, to determine if the anti-CGRP antagonist antibodybinds to the same epitope as other antibodies. Competition assays arewell known to those of skill in the art.

C. Antibody G1 and Related Antibodies, Polypeptides, Polynucleotides,Vectors and Host Cells

This invention encompasses compositions, including pharmaceuticalcompositions, comprising antibody G1 and its variants shown in Table 6or polypeptide derived from antibody G1 and its variants shown in Table6; and polynucleotides comprising sequences encoding G1 and its variantsor the polypeptide. In some embodiments, compositions comprise one ormore antibodies or polypeptides (which may or may not be an antibody)that bind to CGRP, and/or one or more polynucleotides comprisingsequences encoding one or more antibodies or polypeptides that bind toCGRP. These compositions may further comprise suitable excipients, suchas pharmaceutically acceptable excipients including buffers, which arewell known in the art.

In some embodiments, the anti-CGRP antagonist antibodies andpolypeptides of the invention are characterized by any (one or more) ofthe following characteristics: (a) bind to CGRP; (b) block CGRP frombinding to its receptor(s); (c) block or decrease CGRP receptoractivation (including cAMP activation); (d) inhibit CGRP biologicalactivity or downstream pathways mediated by CGRP signaling function; (e)prevent, ameliorate, or treat any aspect of refractory migraine; (f)increase clearance of CGRP; and (g) inhibit (reduce) CGRP synthesis,production or release.

In some embodiments, the invention provides any of the following, orcompositions (including pharmaceutical compositions) comprising any ofthe following: (a) antibody G1 or its variants shown in Table 6; (b) afragment or a region of antibody G1 or its variants shown in Table 6;(c) a light chain of antibody G1 or its variants shown in Table 6; (d) aheavy chain of antibody G1 or its variants shown in Table 6; (e) one ormore variable region(s) from a light chain and/or a heavy chain ofantibody G1 or its variants shown in Table 6; (f) one or more CDR(s)(one, two, three, four, five or six CDRs) of antibody G1 or its variantsshown in Table 6; (g) CDR H3 from the heavy chain of antibody G1; (h)CDR L3 from the light chain of antibody G1 or its variants shown inTable 6; (i) three CDRs from the light chain of antibody G1 or itsvariants shown in Table 6; (j) three CDRs from the heavy chain ofantibody G1 or its variants shown in Table 6; (k) three CDRs from thelight chain and three CDRs from the heavy chain, of antibody G1 or itsvariants shown in Table 6; and (l) an antibody comprising any one of (b)through (k). In some embodiments, the invention also providespolypeptides comprising any one or more of the above.

The CDR portions of antibody G1 (including Chothia and Kabat CDRs) arediagrammatically depicted in FIG. 5. Determination of CDR regions iswell within the skill of the art. It is understood that in someembodiments, CDRs can be a combination of the Kabat and Chothia CDR(also termed “combined CDRs” or “extended CDRs”). In some embodiments,the CDRs are the Kabat CDRs. In other embodiments, the CDRs are theChothia CDRs. In other words, in embodiments with more than one CDR, theCDRs may be any of Kabat, Chothia, combination CDRs, or combinationsthereof.

In some embodiments, the invention provides a polypeptide (which may ormay not be an antibody) which comprises at least one CDR, at least two,at least three, or at least four, at least five, or all six CDRs thatare substantially identical to at least one CDR, at least two, at leastthree, at least four, at least five or all six CDRs of G1 or itsvariants shown in Table 6. Other embodiments include antibodies whichhave at least two, three, four, five, or six CDR(s) that aresubstantially identical to at least two, three, four, five or six CDRsof G1 or derived from G1. In some embodiments, the at least one, two,three, four, five, or six CDR(s) are at least about 85%, 86%, 87%, 88%,89%, 90%, 95%, 96%, 97%, 98%, or 99% identical to at least one, two,three, four, five or six CDRs of G1 or its variants shown in Table 6. Itis understood that, for purposes of this invention, binding specificityand/or overall activity is generally retained, although the extent ofactivity may vary compared to G1 or its variants shown in Table 6 (maybe greater or lesser).

In some embodiments, the invention also provides a polypeptide (whichmay or may not be an antibody) which comprises an amino acid sequence ofG1 or its variants shown in Table 6 that has any of the following: atleast 5 contiguous amino acids, at least 8 contiguous amino acids, atleast about 10 contiguous amino acids, at least about 15 contiguousamino acids, at least about 20 contiguous amino acids, at least about 25contiguous amino acids, at least about 30 contiguous amino acids of asequence of G1 or its variants shown in Table 6, wherein at least 3 ofthe amino acids are from a variable region of G1 (FIG. 5) or itsvariants shown in Table 6. In one embodiment, the variable region isfrom a light chain of G1. In another embodiment, the variable region isfrom a heavy chain of G1. An exemplary polypeptide has contiguous aminoacid (lengths described above) from both the heavy and light chainvariable regions of G1. In another embodiment, the 5 (or more)contiguous amino acids are from a complementarity determining region(CDR) of G1 shown in FIG. 5. In some embodiments, the contiguous aminoacids are from a variable region of G1.

The binding affinity (K_(D)) of an anti-CGRP antagonist antibody andpolypeptide to CGRP (such as human α-CGRP) can be about 0.06 to about200 nM. In some embodiments, the binding affinity is any of about 200nM, 100 nM, about 50 nM, about 10 nM, about 1 nM, about 500 pM, about100 pM, about 60 pM, about 50 pM, about 20 pM, about 15 pM, about 10 pM,about 5 pM, or about 2 pM. In some embodiments, the binding affinity isless than any of about 250 nM, about 200 nM, about 100 nM, about 50 nM,about 10 nM, about 1 nM, about 500 pM, about 100 pM, or about 50 pM.

The antibodies provided herein can be made by procedures known in theart. The polypeptides can be produced by proteolytic or otherdegradation of the antibodies, by recombinant methods (i.e., single orfusion polypeptides) as described above or by chemical synthesis.Polypeptides of the antibodies, especially shorter polypeptides up toabout 50 amino acids, are conveniently made by chemical synthesis.Methods of chemical synthesis are known in the art and are commerciallyavailable. For example, an antibody could be produced by an automatedpolypeptide synthesizer employing the solid phase method. See also, U.S.Pat. Nos. 5,807,715; 4,816,567; and 6,331,415.

In another alternative, the antibodies can be made recombinantly usingprocedures that are well known in the art. In one embodiment, apolynucleotide comprises a sequence encoding the heavy chain and/or thelight chain variable regions of antibody G1 shown in SEQ ID NO:9 and SEQID NO:10. In another embodiment, the polynucleotide comprising thenucleotide sequence shown in SEQ ID NO:9 and SEQ ID NO:10 are clonedinto one or more vectors for expression or propagation. The sequenceencoding the antibody of interest may be maintained in a vector in ahost cell and the host cell can then be expanded and frozen for futureuse. Vectors (including expression vectors) and host cells are furtherdescribed herein.

In some embodiments, the invention also encompasses single chainvariable region fragments (“scFv”) of antibodies of this invention, suchas G1. Single chain variable region fragments are made by linking lightand/or heavy chain variable regions by using a short linking peptide.Bird et al. (1988) Science 242:423-426. An example of a linking peptideis (GGGGS)3 (SEQ ID NO:57) which bridges approximately 3.5 nm betweenthe carboxy terminus of one variable region and the amino terminus ofthe other variable region. Linkers of other sequences have been designedand used. Bird et al. (1988). Linkers can in turn be modified foradditional functions, such as attachment of drugs or attachment to solidsupports. The single chain variants can be produced either recombinantlyor synthetically. For synthetic production of scFv, an automatedsynthesizer can be used. For recombinant production of scFv, a suitableplasmid containing polynucleotide that encodes the scFv can beintroduced into a suitable host cell, either eukaryotic, such as yeast,plant, insect or mammalian cells, or prokaryotic, such as E. coli.Polynucleotides encoding the scFv of interest can be made by routinemanipulations such as ligation of polynucleotides. The resultant scFvcan be isolated using standard protein purification techniques known inthe art.

Other forms of single chain antibodies, such as diabodies are alsoencompassed. Diabodies are bivalent, bispecific antibodies in which VHand VL domains are expressed on a single polypeptide chain, but using alinker that is too short to allow for pairing between the two domains onthe same chain, thereby forcing the domains to pair with complementarydomains of another chain and creating two antigen binding sites (seee.g., Holliger, P., et al. (1993) Proc. Natl. Acad Sci. USA90:6444-6448; Poljak, R. J., et al. (1994) Structure 2:1121-1123).

For example, bispecific antibodies, monoclonal antibodies that havebinding specificities for at least two different antigens, can beprepared using the antibodies disclosed herein. Methods for makingbispecific antibodies are known in the art (see, e.g., Suresh et al.,1986, Methods in Enzymology 121:210). Traditionally, the recombinantproduction of bispecific antibodies was based on the coexpression of twoimmunoglobulin heavy chain-light chain pairs, with the two heavy chainshaving different specificities (Millstein and Cuello, 1983, Nature 305,537-539).

According to one approach to making bispecific antibodies, antibodyvariable domains with the desired binding specificities(antibody-antigen combining sites) are fused to immunoglobulin constantdomain sequences. The fusion preferably is with an immunoglobulin heavychain constant domain, comprising at least part of the hinge, CH2 andCH3 regions. It is preferred to have the first heavy chain constantregion (CH1), containing the site necessary for light chain binding,present in at least one of the fusions. DNAs encoding the immunoglobulinheavy chain fusions and, if desired, the immunoglobulin light chain, areinserted into separate expression vectors, and are cotransfected into asuitable host organism. This provides for great flexibility in adjustingthe mutual proportions of the three polypeptide fragments in embodimentswhen unequal ratios of the three polypeptide chains used in theconstruction provide the optimum yields. It is, however, possible toinsert the coding sequences for two or all three polypeptide chains inone expression vector when the expression of at least two polypeptidechains in equal ratios results in high yields or when the ratios are ofno particular significance.

In one approach, the bispecific antibodies are composed of a hybridimmunoglobulin heavy chain with a first binding specificity in one arm,and a hybrid immunoglobulin heavy chain-light chain pair (providing asecond binding specificity) in the other arm. This asymmetric structure,with an immunoglobulin light chain in only one half of the bispecificmolecule, facilitates the separation of the desired bispecific compoundfrom unwanted immunoglobulin chain combinations. This approach isdescribed in PCT Publication No. WO 94/04690.

Heteroconjugate antibodies, comprising two covalently joined antibodies,are also within the scope of the invention. Such antibodies have beenused to target immune system cells to unwanted cells (U.S. Pat. No.4,676,980), and for treatment of HIV infection (PCT applicationpublication Nos. WO 91/00360 and WO 92/200373; EP 03089).Heteroconjugate antibodies may be made using any convenientcross-linking methods. Suitable cross-linking agents and techniques arewell known in the art, and are described in U.S. Pat. No. 4,676,980.

Chimeric or hybrid antibodies also may be prepared in vitro using knownmethods of synthetic protein chemistry, including those involvingcross-linking agents. For example, immunotoxins may be constructed usinga disulfide exchange reaction or by forming a thioether bond. Examplesof suitable reagents for this purpose include iminothiolate andmethyl-4-mercaptobutyrimidate.

Humanized antibody comprising one or more CDRs of antibody G1 or itsvariants shown in Table 6, or one or more CDRs derived from antibody G1or its variants shown in Table 6 can be made using any methods known inthe art. For example, four general steps may be used to humanize amonoclonal antibody.

In some embodiments, the invention encompasses modifications to antibodyG1 or its variants shown in Table 6, including functionally equivalentantibodies which do not significantly affect their properties andvariants which have enhanced or decreased activity and/or affinity. Forexample, the amino acid sequence of antibody G1 or its variants shown inTable 6 may be mutated to obtain an antibody with the desired bindingaffinity to CGRP. Modification of polypeptides is routine practice inthe art and need not be described in detail herein. Modification ofpolypeptides is exemplified in the Examples. Examples of modifiedpolypeptides include polypeptides with conservative substitutions ofamino acid residues, one or more deletions or additions of amino acidswhich do not significantly deleteriously change the functional activity,or use of chemical analogs.

Amino acid sequence insertions include amino- and/or carboxyl-terminalfusions ranging in length from one residue to polypeptides containing ahundred or more residues, as well as intrasequence insertions of singleor multiple amino acid residues. Examples of terminal insertions includean antibody with an N-terminal methionyl residue or the antibody fusedto an epitope tag. Other insertional variants of the antibody moleculeinclude the fusion to the N- or C-terminus of the antibody of an enzymeor a polypeptide which increases the serum half-life of the antibody.

Substitution variants have at least one amino acid residue in theantibody molecule removed and a different residue inserted in its place.The sites of greatest interest for substitutional mutagenesis includethe hypervariable regions, but FR alterations are also contemplated.Conservative substitutions are shown in Table 1 under the heading of“conservative substitutions”. If such substitutions result in a changein biological activity, then more substantial changes, denominated“exemplary substitutions” in Table 1, or as further described below inreference to amino acid classes, may be introduced and the productsscreened.

TABLE 1 Amino Acid Substitutions Original Residue ConservativeSubstitutions Exemplary Substitutions Ala (A) Val Val; Leu; Ile Arg (R)Lys Lys; Gln; Asn Asn (N) Gln Gln; His; Asp, Lys; Arg Asp (D) Glu Glu;Asn Cys (C) Ser Ser; Ala Gln (Q) Asn Asn; Glu Glu (E) Asp Asp; Gln Gly(G) Ala Ala His (H) Arg Asn; Gln; Lys; Arg Ile (I) Leu Leu; Val; Met;Ala; Phe; Norleucine Leu (L) Ile Norleucine; Ile; Val; Met; Ala; Phe Lys(K) Arg Arg; Gln; Asn Met (M) Leu Leu; Phe; Ile Phe (F) Tyr Leu; Val;Ile; Ala; Tyr Pro (P) Ala Ala Ser (S) Thr Thr Thr (T) Ser Ser Trp (VV)Tyr Tyr; Phe Tyr (Y) Phe Trp; Phe; Thr; Ser Val (V) Leu Ile; Leu; Met;Phe; Ala; Norleucine

Substantial modifications in the biological properties of the antibodyare accomplished by selecting substitutions that differ significantly intheir effect on maintaining (a) the structure of the polypeptidebackbone in the area of the substitution, for example, as a sheet orhelical conformation, (b) the charge or hydrophobicity of the moleculeat the target site, or (c) the bulk of the side chain. Naturallyoccurring residues are divided into groups based on common side-chainproperties:

-   -   (1) Non-polar: Norleucine, Met, Ala, Val, Leu, Ile;    -   (2) Polar without charge: Cys, Ser, Thr, Asn, Gin;    -   (3) Acidic (negatively charged): Asp, Glu;    -   (4) Basic (positively charged): Lys, Arg;    -   (5) Residues that influence chain orientation: Gly, Pro; and    -   (6) Aromatic: Trp, Tyr, Phe, His.

Non-conservative substitutions are made by exchanging a member of one ofthese classes for another class.

Any cysteine residue not involved in maintaining the proper conformationof the antibody also may be substituted, generally with serine, toimprove the oxidative stability of the molecule and prevent aberrantcross-linking. Conversely, cysteine bond(s) may be added to the antibodyto improve its stability, particularly where the antibody is an antibodyfragment such as an Fv fragment.

Amino acid modifications can range from changing or modifying one ormore amino acids to complete redesign of a region, such as the variableregion. Changes in the variable region can alter binding affinity and/orspecificity. In some embodiments, no more than one to five conservativeamino acid substitutions are made within a CDR domain. In otherembodiments, no more than one to three conservative amino acidsubstitutions are made within a CDR domain. In still other embodiments,the CDR domain is CDR H3 and/or CDR L3.

Modifications also include glycosylated and nonglycosylatedpolypeptides, as well as polypeptides with other post-translationalmodifications, such as, for example, glycosylation with differentsugars, acetylation, and phosphorylation. Antibodies are glycosylated atconserved positions in their constant regions (Jefferis and Lund, 1997,Chem. Immunol. 65:111-128; Wright and Morrison, 1997, TibTECH 15:26-32).The oligosaccharide side chains of the immunoglobulins affect theprotein's function (Boyd et al., 1996, Mol. Immunol. 32:1311-1318;Wittwe and Howard, 1990, Biochem. 29:4175-4180) and the intramolecularinteraction between portions of the glycoprotein, which can affect theconformation and presented three-dimensional surface of the glycoprotein(Hefferis and Lund, supra; Wyss and Wagner, 1996, Current Opin. Biotech.7:409-416). Oligosaccharides may also serve to target a givenglycoprotein to certain molecules based upon specific recognitionstructures. Glycosylation of antibodies has also been reported to affectantibody-dependent cellular cytotoxicity (ADCC). In particular, CHOcells with tetracycline-regulated expression ofβ(1,4)-N-acetylglucosaminyltransferase III (GnTIII), aglycosyltransferase catalyzing formation of bisecting GlcNAc, wasreported to have improved ADCC activity (Umana et al., 1999, MatureBiotech. 17:176-180).

Glycosylation of antibodies is typically either N-linked or O-linked.N-linked refers to the attachment of the carbohydrate moiety to the sidechain of an asparagine residue. The tripeptide sequencesasparagine-X-serine, asparagine-X-threonine, and asparagine-X-cysteine,where X is any amino acid except proline, are the recognition sequencesfor enzymatic attachment of the carbohydrate moiety to the asparagineside chain. Thus, the presence of either of these tripeptide sequencesin a polypeptide creates a potential glycosylation site. O-linkedglycosylation refers to the attachment of one of the sugarsN-acetylgalactosamine, galactose, or xylose to a hydroxyamino acid, mostcommonly serine or threonine, although 5-hydroxyproline or5-hydroxylysine may also be used.

Addition of glycosylation sites to the antibody is convenientlyaccomplished by altering the amino acid sequence such that it containsone or more of the above-described tripeptide sequences (for N-linkedglycosylation sites). The alteration may also be made by the additionof, or substitution by, one or more serine or threonine residues to thesequence of the original antibody (for O-linked glycosylation sites).

Other methods of modification include using coupling techniques known inthe art, including, but not limited to, enzymatic means, oxidativesubstitution and chelation. Modifications can be used, for example, forattachment of labels for immunoassay. Modified G1 polypeptides can bemade using established procedures in the art and can be screened usingstandard assays known in the art, some of which are described below andin the Examples.

In some embodiments of the invention, the antibody comprises a modifiedconstant region, such as a constant region that is immunologically inertor partially inert, e.g., does not trigger complement mediated lysis,does not stimulate antibody-dependent cell mediated cytotoxicity (ADCC),or does not activate microglia; or have reduced activities (compared tothe unmodified antibody) in any one or more of the following: triggeringcomplement mediated lysis, stimulating antibody-dependent cell mediatedcytotoxicity (ADCC), or activating microglia. Different modifications ofthe constant region may be used to achieve optimal level and/orcombination of effector functions. See, for example, Morgan et al.,Immunology 86:319-324 (1995); Lund et al., J. Immunology 157:4963-9157:4963-4969 (1996); Idusogie et al., J. Immunology 164:4178-4184(2000); Tao et al., J. Immunology 143: 2595-2601 (1989); and Jefferis etal., Immunological Reviews 163:59-76 (1998). In some embodiments, theconstant region is modified as described in Eur. J. Immunol. (1999)29:2613-2624; PCT Application No. PCT/GB99/01441; and/or UK PatentApplication No. 9809951.8. In other embodiments, the antibody comprisesa human heavy chain IgG2 constant region comprising the followingmutations: A330P331 to S330S331 (amino acid numbering with reference tothe wildtype IgG2 sequence). Eur. J. Immunol. (1999) 29:2613-2624. Instill other embodiments, the constant region is aglycosylated forN-linked glycosylation. In some embodiments, the constant region isaglycosylated for N-linked glycosylation by mutating the glycosylatedamino acid residue or flanking residues that are part of theN-glycosylation recognition sequence in the constant region. Forexample, N-glycosylation site N297 may be mutated to A, Q, K, or H. See,Tao et al., J. Immunology 143: 2595-2601 (1989); and Jefferis et al.,Immunological Reviews 163:59-76 (1998). In some embodiments, theconstant region is aglycosylated for N-linked glycosylation. Theconstant region may be aglycosylated for N-linked glycosylationenzymatically (such as removing carbohydrate by enzyme PNGase), or byexpression in a glycosylation deficient host cell.

Other antibody modifications include antibodies that have been modifiedas described in PCT Publication No. WO 99/58572, published Nov. 18,1999. These antibodies comprise, in addition to a binding domaindirected at the target molecule, an effector domain having an amino acidsequence substantially homologous to all or part of a constant domain ofa human immunoglobulin heavy chain. These antibodies are capable ofbinding the target molecule without triggering significant complementdependent lysis, or cell-mediated destruction of the target. In someembodiments, the effector domain is capable of specifically binding FcRnand/or FcγRIIb. These are typically based on chimeric domains derivedfrom two or more human immunoglobulin heavy chain C_(H)2 domains.Antibodies modified in this manner are particularly suitable for use inchronic antibody therapy, to avoid inflammatory and other adversereactions to conventional antibody therapy.

In some embodiments, the invention includes affinity maturedembodiments. For example, affinity matured antibodies can be produced byprocedures known in the art (Marks et al., 1992, Bio/Technology,10:779-783; Barbas et al., 1994, Proc Nat. Acad. Sci, USA 91:3809-3813;Schier et al., 1995, Gene, 169:147-155; Yelton et al., 1995, J.Immunol., 155:1994-2004; Jackson et al., 1995, J. Immunol.,154(7):3310-9; Hawkins et al, 1992, J. Mol. Biol., 226:889-896; andWO2004/058184).

In some embodiments, the invention also encompasses fusion proteinscomprising one or more fragments or regions from the antibodies (such asG1) or polypeptides of this invention. In one embodiment, a fusionpolypeptide is provided that comprises at least 10 contiguous aminoacids of the variable light chain region shown in SEQ ID NO:2 (FIG. 5)and/or at least 10 amino acids of the variable heavy chain region shownin SEQ ID NO:1 (FIG. 5). In other embodiments, a fusion polypeptide isprovided that comprises at least about 10, at least about 15, at leastabout 20, at least about 25, or at least about 30 contiguous amino acidsof the variable light chain region shown in SEQ ID NO:2 (FIG. 5) and/orat least about 10, at least about 15, at least about 20, at least about25, or at least about 30 contiguous amino acids of the variable heavychain region shown in SEQ ID NO:1 (FIG. 5). In another embodiment, thefusion polypeptide comprises a light chain variable region and/or aheavy chain variable region of G1, as shown in SEQ ID NO:2 and SEQ IDNO:1 of FIG. 5. In another embodiment, the fusion polypeptide comprisesone or more CDR(s) of G1. In still other embodiments, the fusionpolypeptide comprises CDR H3 and/or CDR L3 of antibody G1. For purposesof this invention, an G1 fusion protein contains one or more G1antibodies and another amino acid sequence to which it is not attachedin the native molecule, for example, a heterologous sequence or ahomologous sequence from another region. Exemplary heterologoussequences include, but are not limited to a “tag” such as a FLAG tag ora 6His tag (SEQ ID NO:56). Tags are well known in the art.

In some embodiments, the invention also provides compositions (includingpharmaceutical compositions) and kits comprising antibody G1, and/or anyor all of the antibodies or polypeptides described herein.

Preferably, the “percentage of sequence identity” is determined bycomparing two optimally aligned sequences over a window of comparison ofat least 20 positions, wherein the portion of the polynucleotide orpolypeptide sequence in the comparison window may comprise additions ordeletions (i.e., gaps) of 20 percent or less, usually 5 to 15 percent,or 10 to 12 percent, as compared to the reference sequences (which doesnot comprise additions or deletions) for optimal alignment of the twosequences. The percentage is calculated by determining the number ofpositions at which the identical nucleic acid bases or amino acidresidue occurs in both sequences to yield the number of matchedpositions, dividing the number of matched positions by the total numberof positions in the reference sequence (i.e., the window size) andmultiplying the results by 100 to yield the percentage of sequenceidentity.

Variants may also, or alternatively, be substantially homologous to anative gene, or a portion or complement thereof. Such polynucleotidevariants are capable of hybridizing under moderately stringentconditions to a naturally occurring DNA sequence encoding a nativeantibody (or a complementary sequence).

D. Compositions

In some embodiments, compositions used in a method of the inventioncomprise an effective amount of an antibody (e.g., anti-CGRP antagonistantibody, monoclonal antibody that modulates the CGRP pathway) or anantibody derived polypeptide described herein. Examples of suchcompositions, as well as how to formulate, are also described in anearlier section and below. In one embodiment, the composition furthercomprises a CGRP antagonist. In some embodiments, the compositioncomprises one or more monoclonal antibodies that modulate the CGRPpathway. In some embodiments, the composition comprises one or moreanti-CGRP antagonist antibodies. In some embodiments, the anti-CGRPantagonist antibody recognizes human CGRP. In some embodiments, theanti-CGRP antagonist antibody is humanized. In some embodiments, theanti-CGRP antagonist antibody comprises a constant region that does nottrigger an unwanted or undesirable immune response, such asantibody-mediated lysis or ADCC. In some embodiments, the anti-CGRPantagonist antibody comprises one or more CDR(s) of antibody G1 (such asone, two, three, four, five, or, in some embodiments, all six CDRs fromG1). In some embodiments, the anti-CGRP antagonist antibody is human.

It is understood that the compositions can comprise more than oneantibody (e.g., more than one anti-CGRP antagonist antibody—a mixture ofanti-CGRP antagonist antibodies that recognize different epitopes ofCGRP). Other exemplary compositions comprise more than one anti-CGRPantagonist antibodies that recognize the same epitope(s), or differentspecies of anti-CGRP antagonist antibodies that bind to differentepitopes of CGRP.

A composition can further comprise pharmaceutically acceptable carriers,excipients, or stabilizers (Remington: The Science and practice ofPharmacy 20th Ed. (2000) Lippincott Williams and Wilkins, Ed. K. E.Hoover). Acceptable carriers, excipients, or stabilizers are nontoxic torecipients at the dosages and concentrations employed. A therapeuticformulation of an antibody may comprise one or more pharmaceuticallyacceptable carriers, excipients or stabilizes with non-limiting examplesof such species that include buffers such as phosphate, citrate, andother organic acids; salts such as sodium chloride; antioxidantsincluding ascorbic acid and methionine; preservatives (such asoctadecyldimethylbenzyl ammonium chloride; hexamethonium chloride;benzalkonium chloride, benzethonium chloride; phenol, butyl or benzylalcohol; alkyl parabens, such as methyl or propyl paraben; catechol;resorcinol; cyclohexanol; 3-pentanol; and m-cresol); low molecularweight (less than about 10 residues) polypeptides; proteins, such asserum albumin, gelatin, or immunoglobulins; hydrophilic polymers such aspolyvinylpyrrolidone; amino acids (e.g., at concentrations of 0.1 mM to100 mM, 0.1 mM to 1 mM, 0.01 mM to 50 mM, 1 mM to 50 mM, 1 mM to 30 mM,1 mM to 20 mM, 10 mM to 25 mM) such as glycine, glutamine, methionine,asparagine, histidine, arginine, or lysine; monosaccharides,disaccharides, and other carbohydrates including glucose, mannose, ordextrins; chelating agents (e.g., at concentrations of 0.001 mg/mL to 1mg/mL, 0.001 mg/mL to 1 mg/mL, 0.001 mg/mL to 0.1 mg/mL, 0.001 mg/mL to0.01 mg/mL) such as EDTA (e.g., disodium EDTA dihydrate); sugars (e.g.,at concentrations of 1 mg/mL to 500 mg/mL, 10 mg/mL to 200 mg/mL, 10mg/mL to 100 mg/mL, 50 mg/mL to 150 mg/mL) such as sucrose, mannitol,trehalose or sorbitol; salt-forming counter-ions such as sodium; metalcomplexes (e.g., Zn-protein complexes); and/or non-ionic surfactants(e.g., at concentrations of 0.01 mg/mL to 10 mg/mL, 0.01 mg/mL to 1mg/mL, 0.1 mg/mL to 1 mg/mL, 0.01 mg/mL to 0.5 mg/mL) such as TWEEN™(e.g., polysorbate (e.g., polysorbate 20, polysorbate 40, polysorbate60, polysorbate 80)), PLURONICS™ or polyethylene glycol (PEG).Pharmaceutically acceptable excipients are further described herein.

An antibody (e.g., an anti-CGRP antagonist antibody) and compositionsthereof can also be used in conjunction with other agents that serve toenhance and/or complement the effectiveness of the agents.

E. Kits

In one aspect, the invention also provides kits for use in the instantmethods. Kits can include one or more containers comprising an antibodydescribed herein (e.g., an anti-CGRP antagonist antibody (such as ahumanized antibody)) or polypeptide described herein and instructionsfor use in accordance with any of the methods described herein.Generally, these instructions comprise a description of administrationof the antibody to treat, ameliorate or prevent refractory migraineaccording to any of the methods described herein. The kit may furthercomprise a description of selecting an individual suitable for treatmentbased on identifying whether that individual has refractory migraine orwhether the individual is at risk of having refractory migraine. Instill other embodiments, the instructions comprise a description ofadministering an antibody (e.g., anti-CGRP antagonist antibody) to anindividual at risk of having refractory migraine.

In some embodiments, the antibody is a humanized antibody. In someembodiments, the antibody is human. In other embodiments, the antibodyis a monoclonal antibody. In some embodiments, the antibody comprisesone or more CDR(s) of antibody G1 (such as one, two, three, four, five,or, in some embodiments, all six CDRs from G1).

The instructions relating to the use of an antibody (e.g., anti-CGRPantagonist antibody) generally include information as to dosage, dosingschedule, and route of administration for the intended treatment. Thecontainers may be unit doses, bulk packages (e.g., multi-dose packages)or sub-unit doses. Instructions supplied in the kits are typicallywritten instructions on a label or package insert (e.g., a paper sheetincluded in the kit), but machine-readable instructions (e.g.,instructions carried on a magnetic or optical storage disk) are alsoacceptable.

The label or package insert indicates that the composition is used fortreating, ameliorating and/or preventing migraine in a subject havingrefractory migraine. Instructions may be provided for practicing any ofthe methods described herein.

The kits of this invention are in suitable packaging. Suitable packagingincludes, but is not limited to, vials, bottles, jars, flexiblepackaging (e.g., sealed Mylar or plastic bags), and the like. Alsocontemplated are packages for use in combination with a specific device,such as an inhaler, nasal administration device (e.g., an atomizer) oran infusion device such as a minipump. A kit may have a sterile accessport (for example the container may be an intravenous solution bag or avial having a stopper pierceable by a hypodermic injection needle). Thecontainer may also have a sterile access port (for example the containermay be an intravenous solution bag or a vial having a stopper pierceableby a hypodermic injection needle). At least one active agent in thecomposition is an anti-CGRP antagonist antibody and/or a monoclonalantibody that modulates the CGRP pathway. The container may furthercomprise a second pharmaceutically active agent.

Kits may optionally provide additional components such as buffers andinterpretive information. Normally, the kit comprises a container and alabel or package insert(s) on or associated with the container.

Further aspects and embodiments of the present invention are set out inthe following numbered paragraphs:

1. A method of treating a refractory migraine in a subject, the methodcomprising:

selecting a subject who does not respond favorably to a migrainetreatment selected from the group consisting of topiramate,carbamazepine, divalproex sodium, sodium valproate, flunarizine,pizotifen, am itriptyline, venlafaxine, nortriptyline, duloxetine,atenolol, nadolol, metoprolol, propranolol, timolol, andonabotulinumtoxinA; and

administering to the subject a therapeutically effective amount of amonoclonal antibody that modulates the calcitonin gene-related peptide(CGRP) pathway.

2. The method of paragraph 1, wherein the subject does not respondfavorably to the migraine treatment after about three months and/ordevelops adverse side effects.

3. The method of paragraph 1, wherein the monoclonal antibody isadministered to the subject intravenously or subcutaneously.

4. The method of paragraph 1, wherein the monoclonal antibody isadministered at a dose of about 675 mg.

5. The method of paragraph 4, wherein the monoclonal antibody isadministered at a dose of about 225 mg in three separate injections.

6. The method of paragraph 1, wherein the monoclonal antibody isadministered at a dose of about 675 mg followed by subsequent doses ofabout 225 mg at one month intervals.

7. The method of paragraph 1, wherein the monoclonal antibody isadministered at a dose of about 675 mg followed by five subsequent dosesof about 225 mg at one month intervals.

8. The method of paragraph 1, wherein the administering comprisesadministering the antibody to the subject from a pre-filled syringe,pre-filled syringe with a needle safety device, injection pen, orauto-injector comprising a dose of the monoclonal antibody.

9. The method of paragraph 1, wherein the monoclonal antibody isadministered as a formulation comprising the antibody at a concentrationof at least about 150 mg/mL.

10. The method of paragraph 1, wherein the monoclonal antibody isadministered in a volume of less than 2 mL.

11. The method of paragraph 1, wherein the monoclonal antibody is ananti CGRP antagonist antibody.

12. The method of paragraph 1, wherein the monoclonal antibody is humanor humanized.

13. The method of paragraph 1, wherein the monoclonal antibody is ahumanized anti-CGRP antagonist antibody.

14. The method of paragraph 1, wherein the monoclonal antibody comprisesa CDR H1 as set forth in SEQ ID NO:3; a CDR H2 as set forth in SEQ IDNO:4; a CDR H3 as set forth in SEQ ID NO:5; a CDR L1 as set forth in SEQID NO:6; a CDR L2 as set forth in SEQ ID NO:7; and a CDR L3 as set forthin SEQ ID NO:8.

15. The method of paragraph 1, wherein the monoclonal antibody is anIgG1, IgG2, IgG3, or IgG4 antibody.

16. The method of paragraph 1, wherein the subject is human.

17. The method of paragraph 1, comprising administering to the subject asecond agent simultaneously or sequentially with the monoclonalantibody.

18. The method of paragraph 17, wherein monthly use of the second agentby the subject is decreased by at least 15% after administering themonoclonal antibody.

19. A composition for use in accordance with any of the precedingparagraphs.

The following Examples are provided to illustrate but not limit theinvention. It is understood that the examples and embodiments describedherein are for illustrative purposes only and that various modificationsor changes in light thereof will be suggested to persons skilled in theart and are to be included within the spirit and purview of thisapplication. All publications, patents, and patent applications citedherein are hereby incorporated by reference in their entirety for allpurposes to the same extent as if each individual publication, patent orpatent application were specifically and individually indicated to be soincorporated by reference.

EXAMPLES Example 1: Generation and Characterization of MonoclonalAntibodies Directed Against CGRP

Generation of anti-CGRP antibodies. To generate anti-CGRP antibodiesthat have cross-species reactivity for rat and human CGRP, mice wereimmunized with 25-100 μg of human α-CGRP or β-CGRP conjugated to KLH inadjuvant (50 μl per footpad, 100 μl total per mouse) at variousintervals. Immunization was generally performed as described in GeerligsH J et al., 1989, J. Immunol. Methods 124:95-102; Kenney J S et al.,1989, J. Immunol. Methods 121:157-166; and Wicher K et al., 1989, Int.Arch. Allergy Appl. Immunol. 89:128-135. Mice were first immunized with50 μg of human α-CGRP or β-CGRP conjugated to KLH in CFA (completeFreund's adjuvant). After 21 days, mice were secondly immunized with 25μg of human β-CGRP (for mice first immunized with human α-CGRP) orα-CGRP (for mice first immunized with human β-CGRP) conjugated to KLH inIFA (incomplete Freund's adjuvant). Twenty-three days later after thesecond immunization, third immunization was performed with 25 μg of ratα-CGRP conjugated to KLH in IFA. Ten days later, antibody titers weretested using ELISA. Forth immunization was performed with 25 μg of thepeptide (rat α-CGRP-KLH) in IFA 34 days after the third immunization.Final booster was performed with 100 μg soluble peptide (rat α-CGRP) 32days after the forth immunization.

Splenocytes were obtained from the immunized mouse and fused with NSOmyeloma cells at a ratio of 10:1, with polyethylene glycol 1500. Thehybrids were plated out into 96-well plates in DMEM containing 20% horseserum and 2-oxaloacetate/pyruvate/insulin (Sigma), andhypoxanthine/aminopterin/thymidine selection was begun. On day 8, 100 μlof DMEM containing 20% horse serum was added to all the wells.Supernatants of the hybrids were screened by using antibody captureimmunoassay. Determination of antibody class was done withclass-specific second antibodies.

A panel of monoclonal antibody-producing cell lines was selected basedon their binding to human and rat CGRP for further characterization.These antibodies and characteristics are shown below in Tables 2 and 3.

Purification and Fab fragment preparation. Monoclonal antibodiesselected for further characterization were purified from supernatants ofhybridoma cultures using protein A affinity chromatography. Thesupernatants were equilibrated to pH 8. The supernatants were thenloaded to the protein A column MabSelect (Amersham Biosciences#17-5199-02) equilibrated with PBS to pH 8. The column was washed with 5column volumes of PBS, pH 8. The antibodies were eluted with 50 mMcitrate-phosphate buffer, pH 3. The eluted antibodies were neutralizedwith 1 M Phosphate Buffer, pH 8. The purified antibodies were dialyzedwith PBS, pH 7.4. The antibody concentrations were determined bySDS-PAGE, using a murine monoclonal antibody standard curve.

Fabs were prepared by papain proteolysis of the full antibodies usingImmunopure Fab kit (Pierce #44885) and purified by flow through proteinA chromatography following manufacturer instructions. Concentrationswere determined by ELISA and/or SDS-PAGE electrophoresis using astandard Fab of known concentration (determined by amino acid analysis),and by A280 using 1OD=0.6 mg/ml (or theoretical equivalent based on theamino acid sequence).

Affinity determination of the Fabs. Affinities of the anti-CGRPmonoclonal antibodies were determined at either 25° C. or 37° C. usingthe BIACORE3000™ surface plasmon resonance (SPR) system (Biacore, INC,Piscataway N.J.) with the manufacture's own running buffer, HBS-EP (10mM HEPES pH 7.4, 150 mM NaCl, 3 mM EDTA, 0.005% v/v polysorbate P20).Affinity was determined by capturing N-terminally biotinylated CGRPpeptides (custom ordered from GenScript Corporation, New Jersey orGlobal Peptide Services, Colorado) via pre-immobilized streptavidin onSA chip and measuring binding kinetics of antibody Fab titrated acrossthe CGRP surface. Biotinylated CGRP was diluted into HBS-EP and injectedover the chip at a concentration of less than 0.001 mg/ml. Usingvariable flow time across the individual chip channels, two ranges ofantigen density were achieved: <50 response units (RU) for detailedkinetic studies and about 800 RU for concentration studies andscreening. Two- or three-fold serial dilutions typically atconcentrations spanning 1-0.1 nM (aimed at 0.1-10× estimated K_(D)) ofpurified Fab fragments were injected for 1 minute at 100 μL/min anddissociation times of 10 minutes were allowed. After each binding cycle,surfaces were regenerated with 25 mM NaOH in 25% v/v ethanol, which wastolerated over hundreds of cycles. Kinetic association rate (k_(on)) anddissociation rate (k_(off)) were obtained simultaneously by fitting thedata to a 1:1 Langmuir binding model (Karlsson, R. Roos, H. Fagerstam,L. Petersson, B. (1994). Methods Enzymology 6. 99-110) using theBIAevaluation program. Global equilibrium dissociation constants (K_(D))or “affinities” were calculated from the ratio K_(D)=k_(off)/k_(on).Affinities of the murine Fab fragments are shown in Tables 2 and 3.

Epitope mapping of the murine anti-CGRP antibodies. To determine theepitope that anti-CGRP antibodies bind on human α-CGRP, bindingaffinities of the Fab fragments to various CGRP fragments were measuredas described above by capturing N-terminally biotinylated CGRP fragmentsamino acids 19-37 and amino acids 25-37 on a SA sensor chip. FIG. 1shows their binding affinities measured at 25° C. As shown in FIG. 1,all antibodies, except antibody 4901, bind to human α-CGRP fragments19-37 and 25-37 with affinity similar to their binding affinity to fulllength human α-CGRP (1-37). Antibody 4901 binds to human α-CGRP fragment25-37 with six-fold lower affinity than binding to full length humanα-CGRP fragment, due mainly to a loss in off-rate. The data indicatethat these anti-CGRP antibodies generally bind to the C-terminal end ofCGRP.

Alanine scanning was performed to further characterize amino acids inhuman α-CGRP involved in binding of anti-CGRP antibodies. Differentvariants of human α-CGRP with single alanine substitutions weregenerated by peptide synthesis. Their amino acid sequences are shown inTable 4 along with all the other peptides used in the Biacore analysis.Affinities of Fab fragments of the anti-CGRP antibodies to thesevariants were determined using Biacore as described above. As shown inFIG. 1, all 12 antibodies target a C-terminal epitope, with amino acidF37 being the most crucial residue. Mutation of F37 to alaninesignificantly lowered the affinity or even completely knocked outbinding of the anti-CGRP antibodies to the peptide. The next mostimportant amino acid residue is G33, however, only the high affinityantibodies (7E9, 8B6, 10A8, and 7D11) were affected by alaninereplacement at this position. Amino acid residue S34 also plays asignificant, but lesser, role in the binding of these four high affinityantibodies.

TABLE 2 Characteristics of the anti-CGRP monoclonal antibodies' bindingto human α-CGRP and their antagonist activity Cell-based blocking IC₅₀(nM binding K_(D) to K_(D) to human α-CGRP sites) at 25° C. human humanbinding to its (room temp.) α-CGRP α-CGRP receptor at 25° C. measured inat 25° C. at 37° C. (measured by cAMP radioligand Antibodies (nM) (nM)activation) binding assay. 7E9 1.0 0.9 Yes 2.5 8B6 1.1 1.2 Yes 4.0 10A82.1 3.0 Yes n.d. 7D11 4.4 5.4 Yes n.d. 6H2 9.3 42 Yes 12.9 4901 61 139Yes 58 14E10 80 179 Yes n.d. 9B8 85 183 No n.d. 13C2 94 379 No n.d. 14A9148 581 No n.d. 6D5 210 647 No n.d. 1C5 296 652 No n.d. Note: Antibody4901 is commercially available (Sigma, Product No. C7113). n.d. = notdetermined

TABLE 3 Characteristics of the anti-CGRP monoclonal antibodies' bindingto rat α-CGRP and antagonist activity Cell-based blocking of binding ofrat α-CGRP In vivo K_(D) to rat to its receptor at 25° C. blocking inα-CGRP at (measured by cAMP saphenous Antibodies 37° C. (nM) activation)nerve assay 4901 3.4 Yes Yes 7E9 47 Yes Yes 6H2 54 No No 8B6 75 Yes Yes7D11 218 Yes Yes 10A8 451 No n.d. 9B8 876 No n.d. 14E10 922 No n.d.13C2 >1000 No n.d. 14A9 >1000 No n.d. 6D5 >1000 No n.d. 105 >1000 Non.d. “n.d.” indicates no test was performed for the antibody.

TABLE 4 Amino acid sequences of human α-CGRP fragments(SEQ ID NOS: 15-40) and related peptides(SEQ ID NOS: 41-47). All peptides areC-terminally amidated except SEQ ID NOS: 36-40.Residues in bold indicate point mutations. SEQ ID CGRPAmino acid sequence NO 1-37 (WT) ACDTATCVTHRLAGLLSRSGGVVKNNFVP 15TNVGSKAF  8-37 VTHRLAGLLSRSGGVVKNNFVPTNVGSKAF 16 19-37SGGVVKNNFVPTNVGSKAF 17 P29A (19-37) SGGVVKNNFVATNVGSKAF 18 K35A (19-37)SGGVVKNNFVPTNVGSAAF 19 K35E (19-37) SGGVVKNNFVPTNVGSEAF 20 K35M (19-37)SGGVVKNNFVPTNVGSMAF 21 K35Q (19-37) SGGVVKNNFVPTNVGSQAF 22 F37A (19-37)SGGVVKNNFVPTNVGSKAA 23 25-38A NNFVPTNVGSKAFA 24 25-37 NNFVPTNVGSKAF 25F27A (25-37) NNAVPTNVGSKAF 26 V28A (25-37) NNFAPTNVGSKAF 27 P29A (25-37)NNFVATNVGSKAF 28 T30A (25-37) NNFVPANVGSKAF 29 N31A (25-37)NNFVPTAVGSKAF 30 V32A (25-37) NNFVPTNAGSKAF 31 G33A (25-37)NNFVPTNVASKAF 32 S34A (25-37) NNFVPTNVGAKAF 33 F37A (25-37)NNFVPTNVGSKAA 34 26-37 NFVPTNVGSKAF 35 19-37-COOH SGGVVKNNFVPTNVGSKAF 3619-36-COOH SGGVVKNNFVPTNVGSKA 37 1-36-COOH ACDTATCVTHRLAGLLSRSGGVVKNNFVP38 TNVGSKA 1-19-COOH ACDTATCVTHRLAGLLSRS 39 1-13-COOH ACDTATCVTHRLA 40rat α (1-37) SCNTATCVTHRLAGLLSRSGGVVKDNFVP 41 TNVGSEAF rat α (19-37)SGGVVKDNFVPTNVGSEAF 42 human β (1-37) ACNTATCVTHRLAGLLSRSGGMVKSNFVP 43TNVGSKAF rat 13(1-37) SCNTATCVTHRLAGLLSRSGGVVKDNFVP 44 TNVGSKAFHuman calcitonin CGNLSTCMLGTYTQDFNKFHTFPQTAIGV 45 (1-32) GAPHuman amylin KCNTATCATQRLANFLVHSSNNFGAILSS 46 (1-37) TNVGSNTY HumanYRQSMNNFQGLRSFGCRFGTCTVQKLAHQ 47 adrenomedullin IYQFTDKDKDNVAPRSKISPQGY(1-52)

Example 2: Screening of Anti-CGRP Antagonist Antibodies Using In VitroAssays

Murine anti-CGRP antibodies were further screened for antagonistactivity in vitro using cell based cAMP activation assay and bindingassay.

Antagonist activity measured by cAMP assay. Five microliters of human orrat α-CGRP (final concentration 50 nM) in the presence or absence of ananti-CGRP antibody (final concentration 1-3000 nM), or rat α-CGRP orhuman α-CGRP (final concentration 0.1 nM-10 μM; as a positive controlfor c-AMP activation) was dispensed into a 384-well plate (Nunc, Cat.No. 264657). Ten microliters of cells (human SK-N-MC if human α-CGRP isused, or rat L6 from ATCC if rat α-CGRP is used) in stimulation buffer(20 mM HEPES, pH 7.4, 146 mM NaCl, 5 mM KCl, 1 mM CaCl₂), 1 mM MgCl₂,and 500 μM 3-Isobutyl-1-methylxanthine (IBMX)) were added into the wellsof the plate. The plate was incubated at room temperature for 30minutes.

After the incubation, cAMP activation was performed using HitHunter™Enzyme Fragment Complementation Assay (Applied Biosystems) followingmanufacture's instruction. The assay is based on a geneticallyengineered β-galactosidase enzyme that consists of two fragments-termedEnzyme Acceptor (EA) and Enzyme Donor (ED). When the two fragments areseparated, the enzyme is inactive. When the fragments are together theycan recombine spontaneously to form active enzyme by a process calledcomplementation. The EFC assay platform utilizes an ED-cAMP peptideconjugate in which cAMP is recognized by anti-cAMP. This ED fragment iscapable of reassociation with EA to form active enzyme. In the assay,anti-cAMP antibody is optimally titrated to bind ED-cAMP conjugate andinhibit enzyme formation. Levels of cAMP in cell lysate samples competewith ED-cAMP conjugate for binding to the anti-cAMP antibody. The amountof free ED conjugate in the assay is proportional to the concentrationof cAMP. Therefore, cAMP is measured by the formation of active enzymethat is quantified by the turnover of β-galactosidase luminescentsubstrate. The cAMP activation assay was performed by adding 10 μl oflysis buffer and anti-cAMP antibody (1:1 ratio) following by incubationat room temperature for 60 min. Then 10 μl of ED-cAMP reagent was addedinto each well and incubated for 60 minutes at room temperature. Afterthe incubation, 20 μl of EA reagent and CL mixture (containing thesubstrate) (1:1 ratio) was added into each well and incubated for 1-3hours or overnight at room temperature. The plate was read at 1second/well on PMT instrument or 30 seconds/place on imager. Theantibodies that inhibit activation of cAMP by α-CGRP were identified(referred to as “yes”) in Tables 2 and 3 above. Data in Tables 2 and 3indicate that antibodies that demonstrated antagonist activity in theassay generally have high affinity. For example, antibodies having K_(D)(determined at 25° C.) of about 80 nM or less to human α-CGRP or havingK_(D) (determined at 37° C.) of about 47 nM or less to rat α-CGRP showedantagonist activity in this assay.

Radioligand binding assay. Binding assay was performed to measure theIC₅₀ of anti-CGRP antibody in blocking the CGRP from binding to thereceptor as described previously. Zimmermann et al., Peptides 16:421-4,1995; Mallee et al., J. Biol. Chem. 277:14294-8, 2002. Membranes (25 μg)from SK-N-MC cells were incubated for 90 min at room temperature inincubation buffer (50 mM Tris-HCl, pH 7.4, 5 mM MgCl₂, 0.1% BSA)containing 10 pM ¹²⁵I-human α-CGRP in a total volume of 1 mL. Todetermine inhibition concentrations (IC₅₀), antibodies or unlabeled CGRP(as a control), from a about 100 fold higher stock solution weredissolved at varying concentrations in the incubation buffer andincubated at the same time with membranes and 10 pM ¹²⁵I-human α-CGRP.Incubation was terminated by filtration through a glass microfiberfilter (GF/B, 1 μm) which had been blocked with 0.5% polyethylemimine.Dose response curves were plotted and K values were determined by usingthe equation: K_(i)=IC₅₀/(1+([ligand]/K_(D)); where the equilibriumdissociation constant K_(D)=8 pM for human α-CGRP to CGRP1 receptor aspresent in SK-N-MC cells, and B_(max)=0.025 pmol/mg protein. Thereported IC₅₀ value (in terms of IgG molecules) was converted to bindingsites (by multiplying it by 2) so that it could be compared with theaffinities (K_(D)) determined by Biacore (see Table 2).

Table 2 shows the IC₅₀ of murine antibodies 7E9, 8B6, 6H2 and 4901. Dataindicate that antibody affinity generally correlates with IC₅₀:antibodies with higher affinity (lower K_(D) values) have lower IC₅₀ inthe radioligand binding assay.

Example 3: Effect of Anti-CGRP Antagonist Antibodies on SkinVasodilatation Induced by Stimulation of Rat Saphenous Nerve

To test antagonist activity of anti-CGRP antibodies, effect of theantibodies on skin vasodilatation by stimulation of rat saphenous nervewas tested using a rat model described previously. Escott et al., Br. J.Pharmacol. 110:772-776, 1993. In this rat model, electrical stimulationof saphenous nerve induces release of CGRP from nerve endings, resultingin an increase in skin blood flow. Blood flow in the foot skin of maleSprague Dawley rats (170-300 g, from Charles River Hollister) wasmeasured after saphenous nerve stimulation. Rats were maintained underanesthesia with 2% isoflurane. Bretylium tosylate (30 mg/kg,administered i.v.) was given at the beginning of the experiment tominimize vasoconstriction due to the concomitant stimulation ofsympathetic fibers of the saphenous nerve. Body temperature wasmaintained at 37° C. by the use of a rectal probe thermostaticallyconnected to a temperature controlled heating pad. Compounds includingantibodies, positive control (CGRP 8-37), and vehicle (PBS, 0.01% Tween20) were given intravenously through the right femoral vein, except forthe experiment shown in FIG. 3, the test compound and the control wereinjected through tail vein, and for experiments shown in FIGS. 2A and2B, antibodies 4901 and 7D11 were injected intraperitoneally (IP).Positive control compound CGRP 8-37 (vasodilatation antagonist), due toits short half-life, was given 3-5 min before nerve stimulation at 400nmol/kg (200 μl). Tan et al., Clin. Sci. 89:656-73, 1995. The antibodieswere given in different doses (1 mg/kg, 2.5 mg/kg, 5 mg/kg, 10 mg/kg,and 25 mg/kg).

For experiments shown in FIGS. 2A and 2B, antibody 4901 (25 mg/kg),antibody 7D11 (25 mg/kg), or vehicle control (PBS with 0.01% Tween 20)was administered intraperitoneally (IP) 72 hours before the electricalpulse stimulation. For experiment shown in FIG. 3, antibody 4901 (1mg/kg, 2.5 mg/kg, 5 mg/kg, or 25 mg/kg) or vehicle control (PBS with0.01% Tween 20) was administered intravenously 24 hours before theelectrical pulse stimulation. After administration of the antibodies orvehicle control, the saphenous nerve of the right hindlimb was exposedsurgically, cut proximally and covered with plastic wrap to preventdrying. A laser Doppler probe was placed over the medio-dorsal side ofthe hindpaw skin, which is the region innervated by the saphenous nerve.Skin blood flow, measured as blood cell flux, was monitored with a laserDoppler flow meter. When a stable base-line flux (less than 5%variation) was established for at least 5 minutes, the nerve was placedover platinum bipolar electrodes and electrically stimulated with 60pulses (2 Hz, 10 V, 1 ms, for 30 seconds) and then again 20 minuteslater. Cumulative change in skin blood flow was estimated by the areaunder the flux-time curve (AUC, which is equal to change in fluxmultiplied by change in time) for each flux response to electrical pulsestimulation. The average of the blood flow response to the twostimulations was taken. Animals were kept under anesthesia for a periodof one to three hours.

As shown in FIG. 2A and FIG. 2B, blood flow increase stimulated byapplying electronic pulses on saphenous nerve was inhibited by thepresence of CGRP 8-37 (400 nmol/kg, administered i.v.), antibody 4901(25 mg/kg, administered ip), or antibody 7D11 (25 mg/kg, administeredip) as compared to the control. CGRP 8-37 was administered 3-5 minutesbefore the saphenous nerve stimulation; and antibodies were administered72 hours before the saphenous nerve stimulation. As shown in FIG. 3,blood flow increase stimulated by applying electronic pulses onsaphenous nerve was inhibited by the presence of antibody 4901 atdifferent doses (1 mg/kg, 2.5 mg/kg, 5 mg/kg, and 25 mg/kg) administeredintravenously at 24 hours before the saphenous nerve stimulation.

For experiments shown in FIGS. 4A and 4B, saphenous nerve was exposedsurgically before antibody administration. The saphenous nerve of theright hindlimb was exposed surgically, cut proximally and covered withplastic wrap to prevent drying. A laser Doppler probe was placed overthe medio-dorsal side of the hindpaw skin, which is the regioninnervated by the saphenous nerve. Skin blood flow, measured as bloodcell flux, was monitored with a laser Doppler flow meter. Thirty toforty-five minutes after bretylium tosylate injection, when a stablebase-line flux (less than 5% variation) was established for at least 5minutes, the nerve was placed over platinum bipolar electrodes andelectrically stimulated (2 Hz, 10V, 1 ms, for 30 seconds) and again 20minutes later. The average of the blood flow flux response to these twostimulations was used to establish the baseline response (time 0) toelectrical stimulation. Antibody 4901 (1 mg/kg or 10 mg/kg), antibody7E9 (10 mg/kg), antibody 8B6 (10 mg/kg), or vehicle (PBS with 0.01%Tween 20) were then administered intravenously (i.v.). The nerve wassubsequently stimulated (2 Hz, 10V, 1 ms, for 30 sec) at 30 minutes, 60minutes, 90 minutes, and 120 minutes after antibody or vehicleadministration. Animals were kept under anesthesia for a period ofapproximately three hours. Cumulative change in skin blood flow wasestimated by the area under the flux-time curve (AUC, which is equal tochange in flux multiplied by change in time) for each flux response toelectrical pulse stimulations.

As shown in FIG. 4A, blood flow increase stimulated by applyingelectronic pulses on saphenous nerve was significantly inhibited by thepresence of antibody 4901 1 mg/kg administered i.v., when electronicpulse stimulation was applied at 60 minutes, 90 minutes, and 120 minutesafter the antibody administration, and blood flow increase stimulated byapplying electronic pulses on saphenous nerve was significantlyinhibited by the presence of antibody 4901 10 mg/kg administered i.v.,when electronic pulse stimulation was applied at 30 minutes, 60 minutes,90 minutes, and 120 minutes after the antibody administration. FIG. 4Bshows that blood flow increase stimulated by applying electronic pulseson saphenous nerve was significantly inhibited by the presence ofantibody 7E9 (10 mg/kg, administered i.v.) when electronic pulsestimulation was applied at 30 min, 60 min, 90 min, and 120 min afterantibody administration, and by the presence of antibody 8B6 (10 mg/kg,administered i.v.) when electronic pulse stimulation was applied at 30min after antibody administration.

These data indicate that antibodies 4901, 7E9, 7D11, and 8B6 areeffective in blocking CGRP activity as measured by skin vasodilatationinduced by stimulation of rat saphenous nerve.

Example 4. Characterization of Anti-CGRP Antibody G1 and its Variants

Amino acid sequences for the heavy chain variable region and light chainvariable region of anti-CGRP antibody G1 are shown in FIG. 5. Thefollowing methods were used for expression and characterization ofantibody G1 and its variants.

Expression vector used. Expression of the Fab fragment of the antibodieswas under control of an IPTG inducible lacZ promoter similar to thatdescribed in Barbas (2001) Phage display: a laboratory manual, ColdSpring Harbor, N.Y., Cold Spring Harbor Laboratory Press pg. 2.10.Vector pComb3X), however, modifications included addition and expressionof the following additional domains: the human Kappa light chainconstant domain and the CH1 constant domain of IgG2 humanimmunoglobulin, Ig gamma-2 chain C region, protein accession numberP01859; Immunoglobulin kappa light chain (Homo sapiens), proteinaccession number CAA09181.

Small scale Fab preparation. From E. coli transformed (either usingelectroporation-competent TG1 cells or chemically-competent Top 10cells) with a Fab library, single colonies were used to inoculate both amaster plate (agar LB+carbenicillin (50 μg/mL)+2% glucose) and a workingplate (2 mL/well, 96-well/plate) where each well contained 1.5 mLLB+carbenicillin (50 μg/mL)+2% glucose. A gas permeable adhesive seal(ABgene, Surrey, UK) was applied to the plate. Both plates wereincubated at 30° C. for 12-16 hours; the working plate was shakenvigorously. The master plate was stored at 4° C. until needed, while thecells from the working plate were pelleted (4000 rpm, 4° C., 20 minutes)and resuspended in 1.0 mL LB+carbenicillin (50 μg/mL)+0.5 mM IPTG toinduce expression of Fabs by vigorous shaking for 5 hours at 30° C.Induced cells were centrifuges at 4000 rpm, 4° C. for 20 minutes andresuspended in 0.6 mL Biacore HB-SEP buffer (10 mM HEPES pH 7.4, 150 mMNaCl, 3 mM EDTA, 0.005% v/v P20). Lysis of HB-SEP resuspended cells wasaccomplished by freezing (−80° C.) and then thawing at 37° C. Celllysates were centrifuged at 4000 rpm, 4° C. for 1 hour to separate thedebris from the Fab-containing supernatants, which were subsequentlyfiltered (0.2 μm) using a Millipore MultiScreen Assay System 96-WellFiltration Plate and vacuum manifold. Biacore was used to analyzefiltered supernatants by injecting them across CGRPs on the sensor chip.Affinity-selected clones expressing Fabs were rescued from the masterplate, which provided template DNA for PCR, sequencing, and plasmidpreparation.

Large scale Fab preparation. To obtain kinetic parameters, Fabs wereexpressed on a larger scale as follows. Erlenmeyer flasks containing 150mL LB+carbenicillin (50 μg/mL)+2% glucose were inoculated with 1 mL of a“starter” overnight culture from an affinity-selected Fab-expressing E.coli clone. The remainder of the starter culture (˜3 mL) was used toprepare plasmid DNA (QIAprep mini-prep, Qiagen kit) for sequencing andfurther manipulation. The large culture was incubated at 30° C. withvigorous shaking until an OD_(600nm) of 1.0 was attained (typically12-16 h). The cells were pelleted by centrifuging at 4000 rpm, 4° C. for20 minutes, and resuspended in 150 mL LB+carbenicillin (50 μg/mL)+0.5 mMIPTG. After 5 hours expression at 30° C., cells were pelleted bycentrifuging at 4000 rpm, 4° C. for 20 minutes, resuspended in 10 mLBiacore HBS-EP buffer, and lysed using a single freeze (−80° C.)/thaw(37° C.) cycle. Cell lysates were pelleted by centrifuging at 4000 rpm,4° C. for one hour, and the supernatant was collected and filtered (0.2um). Filtered supernatants were loaded onto Ni-NTA superflow sepharose(Qiagen, Valencia, Calif.) columns equilibrated with PBS, pH 8, thenwashed with 5 column volumes of PBS, pH 8. Individual Fabs eluted indifferent fractions with PBS (pH 8)+300 mM Imidazole. Fractionscontaining Fabs were pooled and dialyzed in PBS, then quantified byELISA prior to affinity characterization.

Full antibody preparation. For expression of full antibodies, heavy andlight chain variable regions were cloned in mammalian expression vectorsand transfected using lipofectamine into HEK 293 cells for transientexpression. Antibodies were purified using protein A using standardmethods.

Vector pDb.CGRP.hFcGI is an expression vector comprising the heavy chainof the G1 antibody, and is suitable for transient or stable expressionof the heavy chain. Vector pDb.CGRP.hFcGI has nucleotide sequencescorresponding to the following regions: the murine cytomegaloviruspromoter region (nucleotides 7-612); a synthetic intron (nucleotides613-1679); the DHFR coding region (nucleotides 688-1253); human growthhormone signal peptide (nucleotides 1899-1976); heavy chain variableregion of G1 (nucleotides 1977-2621); human heavy chain IgG2 constantregion containing the following mutations: A330P331 to S330S331 (aminoacid numbering with reference to the wildtype IgG2 sequence; see Eur. J.Immunol. (1999) 29:2613-2624). Vector pDb.CGRP.hFcGI was deposited atthe ATCC on Jul. 15, 2005, and was assigned ATCC Accession No. PTA-6867.

Vector pEb.CGRP.hKGI is an expression vector comprising the light chainof the G1 antibody, and is suitable for transient expression of thelight chain. Vector pEb.CGRP.hKGI has nucleotide sequences correspondingto the following regions: the murine cytomegalovirus promoter region(nucleotides 2-613); human EF-1 intron (nucleotides 614-1149); humangrowth hormone signal peptide (nucleotides 1160-1237); antibody G1 lightchain variable region (nucleotides 1238-1558); human kappa chainconstant region (nucleotides 1559-1882). Vector pEb.CGRP.hKGI wasdeposited at the ATCC on Jul. 15, 2005, and was assigned ATCC AccessionNo. PTA-6866.

Biacore assay for affinity determination. Affinities of G1 monoclonalantibody and its variants were determined at either 25° C. or 37° C.using the BIACORE3000™ surface plasmon resonance (SPR) system (Biacore,INC, Piscataway N.J.). Affinity was determined by capturing N-terminallybiotinylated CGRP or fragments via pre-immobilized streptavidin (SAsensor chip) and measuring the binding kinetics of antibody G1 Fabfragments or variants titrated across the CGRP or fragment on the chip.All Biacore assays were conducted in HBS-EP running buffer (10 mM HEPESpH 7.4, 150 mM NaCl, 3 mM EDTA, 0.005% v/v polysorbate P20). CGRPsurfaces were prepared by diluting the N-biotinylated CGRP to aconcentration of less than 0.001 mg/mL into HBS-EP buffer and injectingit across the SA sensor chip using variable contact times. Low capacitysurfaces, corresponding to capture levels <50 response units (RU) wereused for high-resolution kinetic studies, whereas high capacity surfaces(about 800 RU of captured CGRP) were used for concentration studies,screening, and solution affinity determinations. Kinetic data wereobtained by diluting antibody G1 Fab serially in two- or three-foldincrements to concentrations spanning 1 uM-0.1 nM (aimed at 0.1-10×estimated K_(D)). Samples were typically injected for 1 minute at 100μL/min and dissociation times of at least 10 minutes were allowed. Aftereach binding cycle, surfaces were regenerated with 25 mM NaOH in 25% v/vethanol, which was tolerated over hundreds of cycles. An entiretitration series (typically generated in duplicate) was fit globally toa 1:1 Langmuir binding model using the BIAevaluation program. Thisreturned a unique pair of association and dissociation kinetic rateconstants (respectively, k_(on) and k_(off)) for each bindinginteraction, whose ratio gave the equilibrium dissociation constant(K_(D)=k_(off)/k_(on)). Affinities (K_(D) values) determined in this wayare listed in Tables 6 and 7.

High-resolution analysis of binding interactions with extremely slowoffrates. For interactions with extremely slow offrates (in particular,antibody G1 Fab binding to human α-CGRP on the chip at 25° C.),affinities were obtained in a two-part experiment. The protocoldescribed above was used with the following modifications. Theassociation rate constant (k_(on)) was determined by injecting a 2-foldtitration series (in duplicate) spanning 550 nM-1 nM for 30 seconds at100 μL/min and allowing only a 30 second dissociation phase. Thedissociation rate constant (k_(off)) was determined by injecting threeconcentrations (high, medium, and low) of the same titration series induplicate for 30 seconds and allowing a 2-hour dissociation phase. Theaffinity (K_(D)) of each interaction was obtained by combining thek_(on) and k_(off) values obtained in both types of experiments, asshown in Table 5.

Determining solution affinity by Biacore. The solution affinity ofantibody G1 for rat α-CGRP and F37A (19-37) human α-CGRP was measured byBiacore at 37° C. A high capacity CGRP chip surface was used (thehigh-affinity human α-CGRP was chosen for detection purposes) and HBS-EPrunning buffer was flowed at 5 μL/m in. Antibody G1 Fab fragment at aconstant concentration of 5 nM (aimed to be at or below the expectedK_(D) of the solution-based interaction) was pre-incubated withcompeting peptide, either rat α-CGRP or F37A (19-37) human α-CGRP, atfinal concentrations spanning 1 nM to 1 μM in 3-fold serial dilutions.Antibody G1 Fab solutions in the absence or presence of solution-basedcompeting peptide, were injected across CGRP on the chip and thedepletion of binding responses detected at the chip surface as a resultof solution competition was monitored. These binding responses wereconverted to “free Fab concentrations” using a calibration curve, whichwas constructed by titrating antibody G1 Fab alone (5, 2.5, 1.25, 0.625,0.325 and 0 nM) across the CGRP on the chip. “Free Fab concentrations”were plotted against the concentration of competing solution-basedpeptide used to generate each data point and fit to a solution affinitymodel using the BIAevaluation software. The solution affinitiesdetermined (indirectly) in this way are shown in Tables 5 and 7 and wereused to validate the affinities obtained when Fabs are injected directlyacross N-biotinylated CGRPs on a SA chip. The close agreement betweenthe affinities determined by these two methods confirms that tetheringan N-biotinylated version of the CGRP to the chip does not alter itsnative solution binding activity.

Table 5 below shows the binding affinities of antibody G1 to humanα-CGRP, human β-CGRP, rat α-CGRP, and rat β-CGRP determined by Biacore,by flowing Fab fragments across N-biotinylated CGRPs on a SA chip. Tobetter resolve the affinities of binding interactions with extremelyslow offrates, affinities were also determined in a two-part experimentto complement this assay orientation, the solution affinity of the ratα-CGRP interaction was also determined (as described above). The closeagreement of the affinities measured in both assay orientations confirmsthat the binding affinity of the native rat α-CGRP in solution is notaltered when it is N-biotinylated and tethered to a SA chip.

TABLE 5 Binding affinities of antibody G1 Fabs titrated across CGRPs onthe chip CGRP on chip Temp. (° C.) k_(on) (1/Ms) k_(off) (1/s) K_(D)(nM) Human α-CGRP 25 1.86 × 10⁵ 7.80 × 10⁻⁶ 0.042 (7%, n = 4)* Humanα-CGRP 37 5.78 × 10⁵ 3.63 × 10⁻⁵ 0.063 (4%, n = 2)* Human β-CGRP 37 4.51× 10⁵ 6.98 × 10⁻⁵ 0.155 Rat α-CGRP 25 5.08 × 10⁴ 6.18 × 10⁻⁵ 1.22 (12%,n = 2)* Rat α-CGRP 37 1.55 × 10⁵ 3.99 × 10⁻⁴ 2.57* (Solution K_(D) = 10(50%, n = 4)** Rat β-CGRP 37 5.16 × 10⁵ 7.85 × 10⁻⁵ 0.152 *Affinitiesfor α-CGRPs (rat and human) were determined in a high-resolutiontwo-part experiment, in which the dissociation phase was monitored for 2hours (the values for k_(on), k_(off), and K_(D) represent the averageof n replicate experiments with the standard deviation expressed as apercent variance). Affinities for β-CGRPs (rat and human) weredetermined by global analysis using only a 20-min dissociation phase,which was not accurate enough to quantify their extremely offrates(their offrates are likely slower than stated here and therefore theiraffinities are likely even higher). Antibody G1 Fab dissociatedextremely slowly from all CGRPs (except α-rat CGRP) with offrates thatapproached the resolution limit of the Biacore assay (especially at 25°C.). **Solution affinity determined by measuring the depletion ofbinding responses detected at CGRP on the chip for antibody G1 Fabpre-incubated with solution-based rat α-CGRP competitor.

Table 6 below shows antibodies having the amino acid sequence variationas compared to antibody G1 and their affinities to both rat α-CGRP andhuman α-CGRP. All amino acid substitutions of the variants shown inTable 6 are described relative to the sequence of G1. The bindingaffinities of Fab fragments were determined by Biacore by flowing themacross CGRPs on a SA chip.

TABLE 6 Amino acid sequences and binding affinity data for antibody G1variants determined at 37° C. by Biacore. α-rat α-rat α-human α-humanClone L1 L2 H2 HC-FW3 k_(off) (1/s) K_(D) (nM) k_(off) (1/s) K_(D) (nM)G1 3.99 × 10⁻⁴ 2.57 3.63 × 10⁻⁵ 0.063 M1 A100L 1.10 × 10⁻³ 1.73 × 10⁻⁴M2 L99A  2.6 × 10⁻³ 58  3.1 × 10⁻⁴ 3 A100R M3 L99A  2.0 × 10⁻³ 61  2.1 ×10⁻⁴ 1.7 A100S M4 L99A 1.52 × 10⁻³ 84.4 6.95 × 10⁻⁵ 0.43 A100V M5 L99A7.35 × 10⁻⁴ 40.8 3.22 × 10⁻⁵ 0.20 A100Y M6 L99N 7.84 × 10⁻⁴ 43.6 1.33 ×10⁻⁴ 0.83 M7 L99N 9.18 × 10⁻⁴ 51.0 2.43 × 10⁻⁴ 1.52 A100C M8 L99N 7.45 ×10⁻⁴ 41.4 9.20 × 10⁻⁵ 0.58 A100G M9 L99N n.d. n.d. 1.00 × 10⁻⁵ 0.06A100Y M10 L99S 1.51 × 10⁻³ 83.9 1.73 × 10⁻⁴ 1.08 A100S M11 L99S 4.83 ×10⁻³ 268.3 2.83 × 10⁻⁴ 1.77 A100T M12 L99S 1.94 × 10⁻³ 107.8 1.01 × 10⁻⁴0.63 A100V M13 L99T 1.84 × 10⁻³ 102.2 1.86 × 10⁻⁴ 1.16 A100G M14 L99Tn.d. n.d. 1.00 × 10⁻⁵ 0.06 A100K M15 L99T 1.15 × 10⁻³ 63.9 1.58 × 10⁻⁵0.10 A100P M16 L99T 9.96 × 10⁻⁴ 55.3 1.65 × 10⁻⁴ 1.03 A100S M17 L99T2.06 × 10⁻³ 114.4 1.85 × 10⁻⁴ 1.16 A100V M18 L99V 1.22 × 10⁻³ 67.8 7.03× 10⁻⁵ 0.44 A100G M19 L99V n.d. n.d. 1.00 × 10⁻⁵ 0.06 A100R M20 R28WL99R 1.44 × 10⁻³ 80.0 1.36 × 10⁻⁴ 0.85 A100L M21 R28W L99S 6.95 × 10⁻⁴15.2 1.42 × 10⁻⁴ 1.23 M22 R28W L99T 1.10 × 10⁻³ 61.1 1.16 × 10⁻⁴ 0.73M23 R28G L99T 7.99 × 10⁻⁴ 44.4 1.30 × 10⁻⁴ 0.81 A100V M24 R28L L99T 1.04× 10⁻³ 57.8 1.48 × 10⁻⁴ 0.93 A100V M25 R28N L99T  1.4 × 10⁻³ 76  1.4 ×10⁻⁴ 1.3 A100V M26 R28N A57G L99T 9.24 × 10⁻⁴ 51.3 1.48 × 10⁻⁴ 0.93A100V M27 R28N L99T 3.41 × 10⁻³ 189.4 3.57 × 10⁻⁴ 2.23 T30A A100V M28R28N E54R L99T 1.25 × 10⁻³ 69.4 9.96 × 10⁻⁵ 0.62 T30D A57N A100V M29R28N L99T 3.59 × 10⁻³ 199.4 3.80 × 10⁻⁴ 2.38 T30G A100V M30 R28N E54KL99T 6.38 × 10⁻³ 354.4 5.90 × 10⁻⁴ 3.69 T30G A57E A100V M31 R28N E54KL99T 3.61 × 10⁻³ 200.6 3.47 × 10⁻⁴ 2.17 T30G A57G A100V M32 R28N E54KL99T 2.96 × 10⁻³ 164.4 2.71 × 10⁻⁴ 1.69 T30G A57H A100V M33 R28N E54KL99T 9.22 × 10⁻³ 512.2 7.50 × 10⁻⁴ 4.69 T30G A57N A100V S58G M34 R28NE54K L99T 2.17 × 10⁻³ 120.6 6.46 × 10⁻⁴ 4.04 T30G A57N A100V S58T M35R28N E54K L99T 3.99 × 10⁻³ 221.7 3.39 × 10⁻⁴ 2.12 T30G A57S A100V M36R28N L99T 4.79 × 10⁻³ 266.1 2.39 × 10⁻⁴ 1.49 T30R A100V M37 R28N A57GL99T 1.45 × 10⁻³ 80.6 2.26 × 10⁻⁴ 1.41 T30S A100V M38 R28N L99T 5.11 ×10⁻³ 283.9 2.18 × 10⁻⁴ 1.36 T30W A100V M39 R28N G50A A57N L99T 9.95 ×10⁻³ 552.8 4.25 × 10⁻⁴ 2.66 L56T S58Y A100V M40 R28N G50A E54K L99T 0.3620000.0 1.28 × 10⁻³ 8.00 L56T A57L A100V M41 R28N G50A E54K L99T 4.53 ×10⁻³ 251.7 2.10 × 10⁻⁴ 1.31 L56T A57N A100V E64D M42 R28N G50A E54K L99T7.52 × 10⁻³ 417.8 4.17 × 10⁻⁴ 2.61 L56T A57N A100V H61F M43 R28N G50AE54K L99T 4.53 × 10⁻³ 251.7 2.63 × 10⁻⁴ 1.64 L56T A57N A100V S58C M44R28N G50A E54K L99T 6.13 × 10⁻³ 443 2.10 × 10⁻⁴ 2.05 L56T A57N A100VS58E M45 R28N G50A E54K L99T 5.58 × 10⁻³ 259 2.11 × 10⁻⁴ 1.85 L56T A57NA100V S58E E64D M46 R28N G50A E54K L99T 2.94 × 10⁻³ 163.3 5.39 × 10⁻⁴3.37 L56T A57N A100V S58E H61F M47 R28N G50A E54K L99T 8.23 × 10⁻³ 457.23.32 × 10⁻⁴ 2.08 L56T A57N A100V S58G M48 R28N G50A E54K L99T 0.03431905.6 8.42 × 10⁻⁴ 5.26 L56T A57N A100V S58L M49 R28N G50A E54K L99T0.0148 822.2 5.95 × 10⁻⁴ 3.72 L56T A57N A100V S58Y H61F M50 R28N G50AE54K L99T 5.30 × 10⁻³ 294.4 4.06 × 10⁻⁴ 2.54 L56T A57R A100V M51 R28NL561 E54K L99T 1.18 × 10⁻³ 65.6 1.31 × 10⁻⁴ 0.82 A57G A100V M52 R28NL561 E54K L99T 2.29 × 10⁻³ 127.2 2.81 × 10⁻⁴ 1.76 A57N A100V S58A M53R28N L561 E54K L99T 1.91 × 10⁻³ 106.1 3.74 × 10⁻⁴ 2.34 A57N A100V S58GM54 R28N G50A E54K L99T 2.16 × 10⁻³ 120.0 1.79 × 10⁻³ 11.19 T30A A57NA100V S58P M55 R28N L56S E54K L99T 5.85 × 10⁻³ 325.0 4.78 × 10⁻⁴ 2.99T30A A57N A100V S58E E64D M56 R28N L56S E54K L99T 9.35 × 10⁻³ 519.4 4.79× 10⁻⁴ 2.99 T30D A57N A100V H61F M57 R28N L56S E54K L99T 0.0104 1.2003.22 × 10⁻⁴ 3.08 T30D A57N A100V S58E M58 R28N L56S E54K L99T No bindingn.d. 1.95 × 10⁻³ 12.19 T30D A57N A100V S581 H61F M59 R28N L56S E54K L99T0.0123 683.3 5.24 × 10⁻⁴ 3.28 T30D A57N A100V S58N H61F M60 R28N L56SE54K L99T 0.0272 1511.1 9.11 × 10⁻⁴ 5.69 T30D A57N A100V S58R H61F M61R28N A51H E54Q L99T 5.21 × 10⁻³ 289.4 4.59 × 10⁻⁴ 2.87 T30G A57N A100VH61F M62 R28N A51H E54K L99T 5.75 × 10⁻³ 242 5.57 × 10⁻⁴ 5.86 T30G L56TA57N A100V S58E M63 R28N G50A E54K L99T 2.65 × 10⁻³ 147.2 1.50 × 10⁻³9.38 T30G A57N A100V S58T M64 R28N G50A E54K L99T 0.0234 1300.0 1.32 ×10⁻³ 8.25 T30G A57N A100V S58V M65 R28N G50A E54K L99T 4.07 × 10⁻³ 226.18.03 × 10⁻⁴ 5.02 T30G L561 A57C A100V M66 R28N L561 E54K L99T 5.11 ×10⁻³ 283.9 5.20 × 10⁻⁴ 3.25 T30G A57E A100V M67 R28N L561 E54K L99T 1.71× 10⁻³ 95.0 8.20 × 10⁻⁴ 5.13 T30G A57F A100V M68 R28N L561 E54K L99T6.76 × 10⁻³ 375.6 4.28 × 10⁻⁴ 2.68 T30G A57N A100V S58D E64D M69 R28NL561 E54K L99T 1.81 × 10⁻³ 100.6 7.33 × 10⁻⁴ 4.58 T30G A57N A100V S58EM70 R28N L561 E54K L99T 6.07 × 10⁻³ 337.2 5.59 × 10⁻⁴ 3.49 T30G A57SA100V M71 R28N L561 E54K L99T 2.12 × 10⁻³ 117.8 1.28 × 10⁻³ 8.00 T30GA57Y A100V M72 R28N L56S E54K L99T 3.95 × 10⁻³ 219.4 4.00 × 10⁻⁴ 2.50T30G A100V M73 R28N L56S E54K L99T 3.00 × 10⁻³ 166.7 2.55 × 10⁻⁴ 1.59T30G A57N A100V S58Y E64D M74 R28N L56S E54K L99T 6.03 × 10⁻³ 335.0 5.97× 10⁻⁴ 3.73 T30G A57S A100V M75 R28N L56S E54K L99T 1.87 × 10⁻² 1038.91.16 × 10⁻³ 7.25 T30G A57V A100V M76 R28N G50A A57G L99T 1.16 × 10⁻³64.4 3.64 × 10⁻⁴ 2.28 T30S L56T A100V M77 R28N G50A E54K L99T 0.0143794.4 4.77 × 10⁻⁴ 2.98 T30S L56T A57D A100V M78 R28N G50A E54K L99T0.167 9277.8 1.31 × 10⁻³ 8.19 T30S L56T A57N A100V S58T M79 R28N G50AE54K L99T 0.19 10555.6 1.29 × 10⁻³ 8.06 T30S L56T A57P A100V M80 R28NL561 E54K L99T 0.0993 5516.7 2.09 × 10⁻³ 13.06 T30S A57N A100V S58V M81R28N L56S E54K L99T 4.29 × 10⁻³ 238.3 4.90 × 10⁻⁴ 3.06 T30S A57N A100VS58E M82 R28N A51H A57N L99T 6.99 × 10⁻³ 388.3 8.77 × 10⁻⁴ 5.48 T30VL56T A100V M83 R28N A51H E54K L99T No binding n.d. 9.33 × 10⁻⁴ 5.83 T30VL56T A57N A100V S58M H61F M84 R28N A51H E54N L99T 1.76 × 10⁻² 977.8 1.08× 10⁻³ 6.75 T30V L56T A57N A100V

All CDRs including both Kabat and Chothia CDRs. Amino acid residues arenumbered sequentially (see FIG. 5). All clones have L3+H1+H3 sequencesidentical to G1. K_(D)=k_(off)/k_(on). All k_(off) values weredetermined in a screening mode except those that are underlined, whichwere obtained by global analysis of a Fab concentration series (G1 wasanalyzed in a high-resolution mode). Underlined K_(D) values weretherefore determined experimentally by measuring k_(on). Other k_(on)values were estimated to be the same as M25.

n.d.=not determined

To determine the epitope on human α-CGRP that is recognized by antibodyG1, Biacore assays described above were used. Human α-CGRP was purchasedas an N-biotinylated version to enable its high-affinity capture via SAsensor chips. The binding of G1 Fab fragment to the human α-CGRP on thechip in the absence or presence of a CGRP peptide was determined.Typically, a 2000:1 mol peptide/Fab solution (e.g., 10 μM peptide in 50nM G1 Fab) was injected across human α-CGRP on the chip. FIG. 6 showsthe percentage of binding blocked by competing peptide. Data shown inFIG. 6 indicate that peptides that block 100% binding of G1 Fab to humanα-CGRP are 1-37 (WT), 8-37, 26-37, P29A (19-37), K35A (19-37), K35E(19-37), and K35M (19-37) of human α-CGRP; 1-37 of β-CGRP (WT); 1-37 ofrat α-CGRP (WT); and 1-37 of rat 13-CGRP (WT). All these peptides areamidated at the C-terminus. Peptides F37A (19-37) and 19-37 (the latternot amidated at the C-terminus) of human α-CGRP also blocked about 80%to 90% of binding of G1 Fab to human α-CGRP. Peptide 1-36 (not amidatedat the C-terminus) of human α-CGRP blocked about 40% of binding of G1Fab to human α-CGRP. Peptide fragment 19-36 (amidated at the C-terminus)of human α-CGRP; peptide fragments 1-13 and 1-19 of human α-CGRP(neither of which are amidated at the C-terminus); and human amylin,calcitonin, and adrenomedullin (all amidated at the C-terminus) did notcompete with binding of G1 Fab to human α-CGRP on the chip. These datademonstrate that G1 targets a C-terminal epitope of CGRP and that boththe identity of the most terminal residue (F37) and its amidation isimportant for binding.

Binding affinities of G1 Fab to variants of human α-CGRP (at 37° C.) wasalso determined. Table 7 below shows the affinities as measured directlyby titrating G1 Fab across N-biotinylated human α-CGRP and variants onthe chip. Data in Table 7 indicate that antibody G1 binds to aC-terminal epitope with F37 and G33 being the most important residues.G1 does not bind to CGRP when an extra amino acid residue (alanine) isadded at the C-terminal (which is amidated).

TABLE 7 Binding affinities of G1 Fab to human α-CGRP and variantsmeasured at 37° C. (see Table 4 for their amino acid sequences) CGRP onchip k_(on) (1/Ms) k_(off) (1/s) K_(D) (nM) 1-37 (WT) 4.68 × 10⁵ 7.63 ×10⁻⁵ 0.16 (high resolution K_(D) = 0.06) 19-37 4.60 × 10⁵ 7.30 × 10⁻⁵0.16 25-37 3.10 × 10⁵ 8.80 × 10⁻⁵ 0.28 F27A (25-37) 3.25 × 10⁵ 1.24 ×10⁻⁴ 0.38 V28A (25-37) 3.32 × 10⁵ 9.38 × 10⁻⁵ 0.28 P29A (25-37) 2.26 ×10⁵ 1.78 × 10⁻⁴ 0.79 T30A (25-37) 1.79 × 10⁵ 8.41 × 10⁻⁵ 0.47 N31A(25-37) 2.17 × 10⁵ 1.14 × 10⁻⁴ 0.53 V32A (25-37) 2.02 × 10⁵ 3.46 × 10⁻⁴1.71 G33A (25-37) 2.07 × 10⁵ 0.0291 141 S34A (25-37) 2.51 × 10⁵ 7.64 ×10⁻⁴ 3.04 K35A (19-37) 2.23 × 10⁵ 2.97 × 10⁻⁴ 1.33 K35E (19-37) 5.95 ×10⁴ 5.79 × 10⁻⁴ 9.73 K35M (19-37) 2.63 × 10⁵ 1.34 × 10⁻⁴ 0.51 K35Q(19-37) 1.95 × 10⁵ 2.70 × 10⁻⁴ 1.38 F37A (25-37) 8.90 × 10⁴ 8.48 × 10⁻³95 (solution K_(D) = 172 nM) 38A (25-38A) — — No binding detected

The above data indicate that the epitope that antibody G1 binds is onthe C-terminal end of human α-CGRP, and amino acids 33 and 37 on humanα-CGRP are important for binding of antibody G1. Also, the amidation ofresidue F37 is important for binding.

Example 5. Clinical Study

A clinical study is conducted to evaluate the efficacy and safety offremanezumab for prophylactic treatment of migraine in patients withinadequate response to prior preventive treatments. Fremanezumab(TEV-48125) is a fully humanized IgG 2a/kappa monoclonal antibody foradministration by the subcutaneous route for the preventive treatment ofmigraine. Fremanezumab is a potent, selective calcitonin gene-relatedpeptide (CGRP) binder that blocks both CGRP isoforms (α and β CGRP) frombinding to the CGRP receptor.

Objectives

The primary objective of the study is to demonstrate the efficacy offremanezumab administered as monthly and quarterly subcutaneous (sc)injections to adult patients with migraine with inadequate response totwo to four classes of prior preventive treatments as compared withplacebo.

The secondary objective of the study is to further evaluate the efficacyof fremanezumab administered as monthly and quarterly sc injections toadult patients with migraine with inadequate response to two to fourclasses of prior preventive treatments as compared with placebo.

A secondary objective of the study is to evaluate the safety andtolerability of fremanezumab administered as monthly and quarterly scinjections to adult patients with migraine with inadequate response totwo to four classes of prior preventive treatments as compared withplacebo.

The exploratory objectives are as follows:

-   -   to further evaluate the efficacy of fremanezumab in adult        migraine patients with inadequate response to two to four        classes of prior preventive treatments    -   to evaluate immunogenicity and impact of antidrug antibody (ADA)        on clinical outcome    -   to explore the correlation between pharmacokinetic parameters        and efficacy of fremanezumab    -   to explore the relationship between genetic polymorphisms,        migraine onset/severity and efficacy and safety of fremanezumab        Clinical Study Design

A multicenter, randomized, double-blind, placebo-controlled,parallel-group study with an open-lable period is conducted to evaluatethe efficacy, safety, and tolerability of monthly and quarterlysubcutaneous (sc) fremanezumab compared with placebo in patients withchronic migraine (CM) and episodic migraine (EM) with inadequateresponse to prior preventive treatments. The study will consist of ascreening visit, a run-in period (28 days), a 12-week double-blind,placebo-controlled treatment period, a 12-week open-label period, and afollow-up visit 6.0 months after the last dose of fremanezumab for ADAblood sample collection. At the end of the open-label treatment period(4 weeks after the last dose) an end of treatment study visit (visit 8)will be scheduled and patients should return to the care of theirtreating physicians. Patients should be treated with standard of careafter withdrawal from or termination of the 24-week treatmentperiod/study, as appropriate.

Double-Blind Period

At the baseline visit (visit 2), patients are randomly assigned to atreatment group with fremanezumab (2 different dose regimens) or placeboin a 1:1:1 ratio as follows:

-   -   For patients with CM:        -   sc administration of 675 mg of fremanezumab at visit 2            followed by monthly sc administration of 225 mg of            fremanezumab for 2 months or        -   sc administration of 675 mg of fremanezumab at visit 2            followed by monthly sc administration of of matching placebo            for 2 months or        -   3 monthly doses of matching placebo    -   For patients with EM:        -   sc administration of fremanezumab at 225 mg plus 2 matching            placebo injections as first dose followed by monthly sc            administration of 225 mg of fremanezumab for 2 months or        -   sc administration of fremanezumab at 675 mg as first dose            followed by monthly sc administration of matching placebo            for 2 months or        -   3 monthly doses of matching placebo            Open-Label Period

After visit 4, all patients completing the double-blind period enter theopen-label period. All patients (CM and EM) will receive sc 225 mg offremanezumab monthly for 3 months. (visits 5, 6, and 7).

Randomization and treatment assignment for the double-blind period isperformed using electronic interactive response technology (IRT). Thestudy is stratified based on CM or EM, gender, country, and a specialtreatment failure group defined as patients who must have had inadequateresponse to valproic acid. In addition, patients in the specialtreatment failure group must have had inadequate response to 2 to 3other classes of migraine preventive medications, as defined herein. Theproportion of CM and EM patients in the study should be approximately50:50 in each subgroup.

The open-label period will not be randomized as all patients willreceive the same monthly dose (225 mg fremanezumab).

CM is defined as:

Patient fulfills the following criteria for CM in prospectivelycollected baseline information during the 28-day run-in period:

-   -   Headache occurring on ≥15 days    -   On ≥8 days, fulfilling any of the following:        -   ICHD-3 diagnostic criteria C and D for 1.1 Migraine without            aura        -   ICHD-3 criteria B and C for 1.2 Migraine with aura        -   Probable migraine (a migraine subtype where only 1 migraine            criterion is missing)        -   The patient used a triptan or ergot derivative to treat            established headache.            EM is defined as:            The patient fulfills the following criteria for EM in            prospectively collected baseline information during the            28-day run-in period:    -   Headache occurring ≥6 days but <15 days    -   On ≥4 days, fulfilling any of the following:        -   ICHD-3 diagnostic criteria C and D for 1.1 Migraine without            aura        -   ICHD-3 criteria B and C for 1.2 Migraine with aura        -   Probable migraine (a migraine subtype where only 1 migraine            criterion is missing)        -   The patient used a triptan or ergot derivative to treat an            established headache

Blinded treatment is administered sc once a month (approximately every28 days) for a total of 3 doses (visits 2, 3, and 4) and open-labeltreatment is administered for a total of 3 doses (visits 5, 6, and 7).Final study assessments are performed at visit 8 (end-of-treatment [EOT]visit), approximately 4 weeks after administration of last dose offremanezumab. A follow-up visit is scheduled 6.0 months (>5 half-lives)after the last study drug administration for ADA blood sampling.Patients who discontinue early will have the follow-up visit 6.0 monthsafter the last dose. The total duration of patient participation in thestudy is planned to be 50 weeks including a run-in period lasting 28days, a double-blind treatment period lasting 12 weeks, an open-labelperiod lasting 12 weeks, and 1 follow-up visit at week 46. Patients areexpected to complete the entire duration of the study, including theopen-label period and the follow-up visit.

The end of study is defined as the last visit of the last patient(follow-up visit, visit 9). However, an interim database lock occursfollowing the end of the double-blind treatment period of the lastpatient for analysis of that portion of the study data. A second interimlock will occur following the end of the open-label period. The totalstudy duration, including the 6.0-month follow-up-period, isapproximately 2 years.

Endpoints

The primary efficacy endpoint is the mean change from baseline (28-dayrun-in period) in the monthly average number of migraine days during the12-week period after the 1st dose of fremanezumab.

Secondary endpoints to further demonstrate efficacy include:

-   -   The proportion of patients reaching at least 50% reduction in        the monthly average number of migraine days during the 12-week        period after the 1st dose of fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of headache days of at least moderate        severity during the 12-week period after the 1st dose of        fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of migraine days during the 4-week period        after the 1st dose of fremanezumab.    -   The proportion of patients reaching at least 50% reduction in        the monthly average number of migraine days during the 4-week        period after the 1st dose of fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days of use of any acute headache        medications during the 12-week period after the 1st dose of        fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        number of headache days of at least moderate severity during the        4-week period after the 1st dose of fremanezumab.        Secondary endpoints to demonstrate safety and tolerability        include:    -   The occurrence of adverse events throughout the study.    -   Analysis of clinical laboratory (serum chemistry, hematology,        coagulation and urinalysis) test results at specified time        points.    -   Analysis of vital signs (systolic and diastolic blood pressure,        oral temperature, and pulse rate) measurements at each visit.        Note: In addition, oxygen saturation and respiratory rate will        be measured in cases of suspected anaphylaxis and severe        hypersensitivity.    -   Analysis of 12-lead electrocardiogram (ECG) findings at        specified time points.    -   The use of concomitant medication for adverse events during the        study.    -   The number (%) of patients who did not complete the study due to        adverse events.    -   Analysis of clinically significant changes in physical        examinations, including body weight.    -   Occurrence of severe hypersensitivity/anaphylaxis reactions.    -   Suicidal ideations and behaviors as measured by the eC-SSRS.        Exploratory Objectives to Demonstrate Efficacy    -   To evaluate the efficacy of fremanuzumab in adult migraine        patients with inadequate response to two to four classes of        prior preventative treatments        Exploratory endpoints for the double-blind period are as        follows:    -   The proportion of patients reaching at least 75% reduction in        the monthly average number of migraine days during the 12-week        period after the 1st dose of study drug.    -   The proportion of patients reaching total (100%) response (no        headache) during the 12-week period after the 1st dose of study        drug.    -   The proportion of patients reaching total (100%) response (no        headache) for at least one month during the 12-week period after        the 4th dose of study drug    -   The mean change from baseline (28-day run-in period) in the        monthly average number of headache hours of at least moderate        severity during the 12-week period after the (1st) dose of the        study drug.    -   The proportion of patients reaching at least 50% reduction in        the number of migraine days during the 4-week period after the        1st dose of study drug for whom this level of effect is        sustained throughout the 12-week period after the 1st dose of        study drug.    -   The proportion of patients reaching at least 75% reduction in        the number of migraine days during the 4-week period after the        1st dose of study drug for whom this level of effect is        sustained throughout the 12-week period after the 1st dose of        study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days with nausea or vomiting during        the 12-week period after the 1st dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days with photophobia and phonophobia        during the 12-week period after the 1st dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days of use of migraine-specific acute        headache medications (triptans and ergot compounds) during the        12-week period after the 1st dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 1st        dose of study drug for patients who failed topiramate for        migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 1st        dose of study drug for patients who failed onabotulinumtoxinA        for migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 1st        dose of study drug for patients who failed valproic acid for        migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 1st        dose of study drug for the subset of patients who failed 2 to 3        classes of preventive medications and valproic acid for migraine        in the past.    -   The proportion of patients reaching at least 50% reduction in        the monthly average number of migraine days during the 12-week        period after the 1st dose of fremanezumab for the subset of        patients who failed 2 to 3 classes of preventive medications and        valproic acid for migraine in the past    -   The mean change from baseline (day 0) in disability score, as        measured by the 6-item Headache Impact Test (HIT-6), at 4 weeks        after administration of the 3rd dose of study drug.    -   The mean change from baseline (day 0) in disability score, as        measured by the Migraine Disability Assessment (MIDAS)        questionnaire, at 4 weeks after the administration of the 3rd        dose of study drug.    -   The mean change from baseline (day 0) in quality of life, as        measured by the MigraineSpecific Quality of Life (MSQOL)        questionnaire, at 4 weeks after administration of the 3rd dose        of study drug.    -   The mean change from baseline (day 0) in the health status, as        measured by the EuroQol-5 Dimension (EQ-5D-5L) questionnaire at        4 weeks after administration of the 3rd dose of study drug.    -   The mean change from baseline (day 0) in patient depression        status, as measured by the 2 item Patient Health Questionnaire        (PHQ-2) and 9-item Patient Health Questionnaire (PHQ-9), at 4        weeks after administration of the 3rd dose of study drug.    -   The mean change from baseline (day 0) in patient work        productivity and activity impairment, as measured by the Work        Productivity and Activity Impairment (WPAI) questionnaire, at 4        weeks after administration of the 3rd dose of study drug.    -   The mean change from baseline (day 0) of patient satisfaction,        as measured by the Patient Global Impression of Change (PGIC)        scale, at 4 weeks after the 3rd dose of study drug.        Exploratory endpoints for the open-label period are:    -   The mean change from baseline (28-day run-in period) in the        monthly average number of migraine days during the 12-week        period after the 4th dose of fremanezumab.    -   The proportion of patients reaching at least 50% reduction from        baseline (28-day run-in period) in the monthly average number of        migraine days during the 12-week period after the 4th dose of        fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of headache days of at least moderate        severity during the 12-week period after the 4th dose of        fremanezumab.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days of use of any acute headache        medications during the 12-week period after the 4th dose of        fremanezumab.    -   The proportion of patients reaching at least 75% reduction from        baseline (28-day run-in period) in the monthly average number of        migraine days during the 12-week period after the 4th dose of        study drug.    -   The proportion of patients reaching total (100%) response (no        headache) during the 12-week period after the 4th dose of study        drug.    -   The proportion of patients reaching total (100%) response (no        headache) for at least one month during the 12-week period after        the 4th dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of headache hours of at least moderate        severity during the 12-week period after the 4th dose of the        study drug.    -   The proportion of patients reaching at least 50% reduction from        baseline (28-day run-in period) in the number of migraine days        during the 4-week period after the 4th dose of study drug for        whom this level of effect is sustained throughout the 12-week        period after the 4th dose of study drug.    -   The proportion of patients reaching at least 75% reduction from        baseline (28-day run-in period) in the number of migraine days        during the 4-week period after the 4th dose of study drug for        whom this level of effect is sustained throughout the 12-week        period after the 4th dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days with nausea or vomiting during        the 12-week period after the 4th dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days with photophobia and phonophobia        during the 12-week period after the 4th dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        monthly average number of days of use of migraine-specific acute        headache medications (triptans and ergot compounds) during the        12-week period after the 4th dose of study drug.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 4th        dose of study drug for patients who failed topiramate for        migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 4th        dose of study drug for patients who failed onabotulinumtoxinA        for migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 4th        dose of study drug for patients who failed valproic acid for        migraine in the past.    -   The mean change from baseline (28-day run-in period) in the        number of migraine days during the 12-week period after the 4th        dose of study drug for patients who failed 2 to 3 classes of        preventive medications in addition to valproic acid for migraine        in the past.    -   The proportion of patients reaching at least 50% reduction from        baseline (28-day run-in period) in the monthly average number of        migraine days during the 12-week period after the 4th dose of        fremanezumab for patients who failed 2 to 3 classes of        preventive medications in addition to valproic acid for migraine        in the past.    -   The mean change from baseline (day 0) in disability score, as        measured by the HIT-6, at 4 weeks after administration of the        6th dose of study drug.    -   The mean change from baseline (day 0) in disability score, as        measured by the MIDAS questionnaire, at 4 weeks after the        administration of the 6th dose of study drug.    -   The mean change from baseline (day 0) in quality of life, as        measured by the MSQOL questionnaire, at 4 weeks after        administration of the 6th dose of study drug.    -   The mean change from baseline (day 0) in the health status, as        measured by the EQ-5D-5L questionnaire at 4 weeks after        administration of the 6th dose of study drug.    -   The mean change from baseline (day 0) in patient depression        status, as measured by the PHQ-2 and PHQ-9, at 4 weeks after        administration of the 6th dose of study drug.    -   The mean change from baseline (day 0) in patient work        productivity and activity impairment, as measured by the WPAI        questionnaire, at 4 weeks after administration of the 6th dose        of study drug.    -   The mean change from baseline (day 0) of patient satisfaction,        as measured by the PGIC scale, at 4 weeks after the 6th dose of        study drug.        Exploratory endpoints for both the double-blind and open-label        periods:    -   To evaluate the immunogenicity response of fremanezumab and the        impact of ADAs on clinical outcomes in patients exposed to sc        fremanezumab.    -   To explore the relationship between genetic polymorphisms        (including those within the calcitonin gene-related peptide        (CGRP) receptor-ligand complex, in migraine-associated        susceptibility genes, and in as-yet undiscovered loci) versus        migraine onset/severity, adverse events to medication and        fremanezumab efficacy.        Study Population

The study population is composed of male and female patients, aged 18 to70 years, inclusive, with a history of migraine (as defined byInternational Classification of Headache Disorders, 3rd revision[ICHD-3] criteria [IHS 2013]) for at least 12 months prior to screeningand diagnosis of episodic or chronic migraine prospectively documentedvia a review of headache data recorded daily in an electronic dailyheadache diary device during a 28-day run-in period.

At the time of screening, patients must have documented inadequateresponse to two to four classes of prior preventive migraine medicationswithin the past 10 years (in medical chart or by treating physician'sconfirmation).

A subset of these patients (at least 120 patients) must have documentedinadequate response to 2 to 3 classes of prior preventive medicationsand in addition inadequate response to valproic acid. All inadequateresponses must be within the past 10 years (in medical chart or bytreating physician's confirmation).

Prior migraine preventive medications are as follows (see Martelletti etal., J. Headache Pain, 15(1):47, 2014):

-   -   beta-blockers: propranolol, metoprolol, atenolol, and bisopropol    -   anticonvulsants: topiramate    -   tricyclics: amitriptyline    -   calcium channel blocker: flunarizine    -   angiotensin II receptor antagonist: candesartan    -   onabotulinumtoxinA    -   valproic acid

The use of the medications listed above on a daily basis for otherindications is disallowed for the duration of the study. Any of thelisted medications are allowed if given as topical or eye drops. Othermedications in the same classes but not included in this list areallowed.

Inadequate response to prior preventative migraine medications(including valproic acid) is defined as:

-   -   Patients must have documented inadequate response (in medical        chart or by treating physician's confirmation) to two to four        classes of prior preventive medications from the list above        regardless of which class the medication belongs to.    -   Inadequate response is defined as: no clinically meaningful        improvement per treating physician's judgment, after at least 3        months of therapy at a stable dose considered appropriate for        migraine prevention according to accepted country guidelines, or        when treatment has to be interrupted because of adverse events        that made it intolerable by the patient or the drug is        contraindicated or not suitable for the patient. The 3 month        period does not apply if the drug is intolerable or        contraindicated or not suitable for the patient.

If onabotulinumtoxinA is the previously failed preventive medication, atleast 2 sets of injections and 3 months must have passed since the lastset of injections prior to the screening visit.

Patient Inclusion Criteria

Patients are included in the study only if they meet all of thefollowing criteria:

-   -   a. The patient is capable of giving signed informed consent.    -   b. Male or female patient aged 18 to 70 years, inclusive.    -   c. The patient has a diagnosis of migraine with onset at 50        years of age.    -   d. The patient is in good health in the opinion of the        investigators as determined by medical history, physical        examination, laboratory tests, and ECG.    -   e. Body weight ≥45 kg and body mass index (BMI) within the range        17.5 to 34.9 kg/m2 (inclusive).    -   f. The patient has a history of migraine (according to ICHD-3        criteria [IHS 2013]) or clinical judgment suggests a migraine        diagnosis (not better accounted for by another ICHD-3 diagnosis)        for ≥12 months prior to screening.    -   g. The patient fulfills the following criteria for migraine in        prospectively collected baseline information during the 28-day        run-in period:

For Patients with CM:

-   -   Headache occurring on ≥15 days    -   On ≥8 days, fulfilling any of the following:        -   i. ICHD-3 diagnostic criteria C and D for 1.1 Migraine            without aura        -   ii. ICHD-3 criteria B and C for 1.2 Migraine with aura        -   iii. Probable migraine (a migraine subtype where only 1            migraine criterion is missing)        -   iv. The patient used a triptan or ergot derivative to treat            an established headache

For Patients with EM:

-   -   Headache occurring ≥6 days    -   On ≥4 days, fulfilling any of the following:        -   i. ICHD-3 diagnostic criteria C and D for 1.1 Migraine            without aura        -   ii. ICHD-3 criteria B and C for 1.2 Migraine with aura        -   iii. Probable migraine (a migraine subtype where only 1            migraine criterion is missing)        -   iv. The patient used a triptan or ergot derivative to treat            an established headache    -   h. At the time of screening, the patient must have documented        inadequate response to two to four classes of prior preventive        migraine medications, as defined herein, within the past 10        years (in medical chart or by treating physician's        confirmation). Inadequate response to prior preventive migraine        medications (including valproic acid) is defined as: no        clinically meaningful improvement per treating physician's        judgment, after at least 3 months of therapy at a stable dose        considered appropriate for migraine prevention according to        accepted country guidelines, or when treatment has to be        interrupted because of adverse events that made it intolerable        for the patient, or the medication is contraindicated or        unsuitable for the prophylactic treatment of migraine for the        patient. The 3-month period does not apply if the drug is        intolerable or contraindicated. If onabotulinumtoxinA is the        previous preventive medication, at least 2 sets of injections        and 3 months must have passed since the last set of injections        prior to the screening visit.    -   i. The patient agrees not to initiate any migraine medications,        as defined herein, during the run-in period, double-blind        treatment period, and open-label period. At the screening visit,        at least five half-lives of these medications must have passed        since the patient has been on any migraine preventive        medication, as defined herein.    -   j. Other prescription medications not defined as prior migraine        preventive medication as defined herein must have been on stable        doses for at least 2 months at the screening visit with no        expectation to change during the double-blind treatment period        of the study.    -   k. The patient demonstrated compliance with the electronic        headache diary during the run-in period by entry of headache        data on a minimum of 24 days cumulative during the run-in period        (˜85% diary compliance).    -   l. Women may be included only if they have a negative serum        beta-human chorionic gonadotropin (β-HCG) test at screening, are        sterile, or postmenopausal.    -   m. Women of childbearing potential (WOCBP) whose male partners        are potentially fertile (e.g., no vasectomy) must use highly        effective birth control methods for the duration of the study        and the follow-up period (i.e., starting at screening) and for        6.0 months after discontinuation of IMP.    -   n. Men must be sterile, or if they are potentially        fertile/reproductively competent (not surgically [eg, vasectomy]        or congenitally sterile) and their female partners are of        childbearing potential, must use, together with their female        partners, acceptable birth control methods for the duration of        the study and for 6.0 months after discontinuation of the IMP.    -   o. The patient must be willing and able to comply with study        restrictions, to remain at the clinic for the required duration        during the study period and to return to the clinic for the        follow-up evaluations.        Patient Exclusion Criteria        Patients are excluded from participating in this study if they        meet any of the following criteria:    -   a. At the time of screening visit, patient is receiving any        preventive migraine medications, as defined herein, regardless        of the medical indication for more than 5 days and expects to        continue with these medications.    -   b. Patient has received onabotulinumtoxinA for migraine or for        any medical or cosmetic reasons requiring injections in the        head, face, or neck during the 3 months before screening visit.    -   c. The patient uses medications containing opioids (including        codeine) or barbiturates (including butalbital/aspirin/caffeine        [Fiorinal®, Actavis plc], butalbital/paracetamol/caffeine        [Fioricet®, Cardinal Health], or any other combination        containing butalbital) on more than 4 days during the run-in        period for the treatment of migraine or for any other reason.    -   d. The patient has used an intervention/device (e.g., scheduled        nerve blocks and transcranial magnetic stimulation) for migraine        during the 2 months prior to screening.    -   e. The patient uses triptans/ergots as preventive therapies for        migraine.    -   f. Patient uses non-steroidal anti-inflammatory drugs (NSAIDs)        as preventive therapy for migraine on nearly daily basis for        other indications. Note: Low dose aspirin (e.g., 81 mg) used for        cardiovascular disease prevention is allowed.    -   g. The patient suffers from unremitting headaches, defined as        having headaches for more than 80% of the time he/she is awake,        and less than 4 days without headache per month. Daily headache        is acceptable if the patient has headaches 80% or less of the        time he/she is awake on most days.    -   h. The patient has a clinically significant hematological,        cardiac, renal, endocrine, pulmonary, gastrointestinal,        genitourinary, neurologic, hepatic, or ocular disease that, in        the opinion of the investigator, could jeopardize or would        compromise the patient's ability to participate in this study.    -   i. Evidence or medical history of clinically significant        psychiatric issues that, in the opinion of the investigator,        could jeopardize or would compromise the patient's ability to        participate in this study including major depression, panic        disorder, or generalized anxiety disorder, any suicide attempt        in the past or suicidal ideation with a specific plan in the        past two years prior to screening or current suicidal ideation        as measured by eC-SSRS.    -   j. History of clinically significant cardiovascular disease or        vascular ischemia (such as myocardial, neurological [e.g.,        cerebral ischemia], peripheral extremity ischemia, or other        ischemic event) or thromboembolic events (arterial or venous        thrombotic or embolic events), such as cerebrovascular accident        (including transient ischemic attacks), deep vein thrombosis, or        pulmonary embolism.    -   k. History of human immunodeficiency virus, tuberculosis, or        chronic hepatitis B or C infection.    -   l. Past or current history of cancer, except for appropriately        treated non-melanoma skin carcinoma in the last 5 years.    -   m. Pregnant or lactating female patients or female patients who        plan to become pregnant during the study.    -   n. Participation in a clinical study of a new chemical entity or        a prescription medicine within 2 months before screening (or 3        months in case of biologics if the half-life of the biologics is        unknown) or 5 half-lives, whichever is longer, or is currently        participating in another study of an IMP (or a medical device).    -   o. Any prior exposure to a monoclonal antibody targeting the        CGRP pathway (such as AMG 334, ALD304, LY2951742, or        fremanezumab).    -   p. Any finding in the baseline 12-lead ECG considered clinically        significant in the judgment of the investigator.    -   q. Any finding that, in the judgment of the investigator, is a        clinically significant abnormality, including serum chemistry,        hematology, coagulation, and urinalysis test values (abnormal        tests may be repeated for confirmation).    -   r. Hepatic enzymes (alanine aminotransferase, aspartate        aminotransferase, and alkaline phosphatase) >1.5×the upper limit        of the normal (ULN) range after confirmation in a repeat test or        suspected hepatocellular damage that fulfills criteria for Hy's        law at screening.    -   s. Serum creatinine >1.5×the ULN, clinically significant        proteinuria, or evidence of renal disease at screening.    -   t. The patient has a history of alcohol abuse during the 2 years        prior to screening.    -   u. The patient has a history of drug abuse during the past 2        years or drug dependence during the past 5 years.    -   v. The patient cannot participate or successfully complete the        study, in the opinion of their healthcare provider or the        investigator, for any of the following reasons:        -   mentally or legally incapacitated or unable to give consent            for any reason        -   in custody due to an administrative or a legal decision,            under tutelage, or being admitted to a sanitarium or social            institution        -   unable to be contacted in case of emergency        -   has any other condition, which, in the opinion of the            investigator, makes the patient inappropriate for inclusion            in the study    -   w. The patient is a study center or sponsor employee who is        directly involved in the study or the relative of such an        employee.    -   x. The patient has been previously screen failed for the study.        Antibody Sequences

G1 heavy chain variable region amino acid sequence (SEQ ID NO: 1)EVQLVESGGGLVQPGGSLRLSCAASGFTFSNYWISWVRQAPGKGLEWVAEIRSESDASATHYAEAVKGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCLAYFDYGLAIQNYWGQG TLVTVSSG1 light chain variable region amino acid sequence (SEQ ID NO: 2)EIVLTQSPATLSLSPGERATLSCKASKRVTTYVSWYQQKPGQAPRLLIYGASNRYLGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCSQSYNYPYTFGQGTKLEIKG1 CDR H1 (extended CDR) (SEQ ID NO: 3) GFTFSNYWISG1 CDR H2 (extended CDR) (SEQ ID NO: 4) EIRSESDASATHYAEAVKGG1 CDR H3 (SEQ ID NO: 5) YFDYGLAIQNY G1 CDR L1 (SEQ ID NO: 6)KASKRVTTYVS G1 CDR L2 (SEQ ID NO: 7) GASNRYL G1 CDR L3 (SEQ ID NO: 8)SQSYNYPYTG1 heavy chain variable region nucleotide sequence (SEQ ID NO: 9)GAAGTTCAGCTGGTTGAATCCGGTGGTGGTCTGGTTCAGCCAGGTGGTTCCCTGCGTCTGTCCTGCGCTGCTTCCGGTTTCACCTTCTCCAACTACTGGATCTCCTGGGTTCGTCAGGCTCCTGGTAAAGGTCTGGAATGGGTTGCTGAAATCCGTTCCGAATCCGACGCGTCCGCTACCCATTACGCTGAAGCTGTTAAAGGTCGTTTCACCATCTCCCGTGACAACGCTAAGAACTCCCTGTACCTGCAGATGAACTCCCTGCGTGCTGAAGACACCGCTGTTTACTACTGCCTGGCTTACTTTGACTACGGTCTGGCTATCCAGAACTACTGGGGTCAGGGTACCCTGGTTACCGTTTCCTCCG1 light chain variable region nucleotide sequence (SEQ ID NO: 10)GAAATCGTTCTGACCCAGTCCCCGGCTACCCTGTCCCTGTCCCCAGGTGAACGTGCTACCCTGTCCTGCAAAGCTTCCAAACGGGTTACCACCTACGTTTCCTGGTACCAGCAGAAACCCGGTCAGGCTCCTCGTCTGCTGATCTACGGTGCTTCCAACCGTTACCTCGGTATCCCAGCTCGTTTCTCCGGTTCCGGTTCCGGTACCGACTTCACCCTGACCATCTCCTCCCTGGAACCCGAAGACTTCGCTGTTTACTACTGCAGTCAGTCCTACAACTACCCCTACACCTTCGGTCAGGGTACCAAACTGGAAATCAAAG1 heavy chain full antibody amino acid sequence (includingmodified IgG2 as described herein) (SEQ ID NO: 11)EVQLVESGGGLVQPGGSLRLSCAASGFTFSNYWISWVRQAPGKGLEWVAEIRSESDASATHYAEAVKGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCLAYFDYGLAIQNYWGQGTLVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSNFGTQTYTCNVDHKPSNTKVDKTVERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLPSSIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGKG1 light chain full antibody amino acid sequence (SEQ ID NO: 12)EIVLTQSPATLSLSPGERATLSCKASKRVTTYVSWYQQKPGQAPRLLIYGASNRYLGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCSQSYNYPYTFGQGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGECG1 heavy chain full antibody nucleotide sequence (includingmodified IgG2 as described herein) (SEQ ID NO: 13)GAAGTTCAGCTGGTTGAATCCGGTGGTGGTCTGGTTCAGCCAGGTGGTTCCCTGCGTCTGTCCTGCGCTGCTTCCGGTTTCACCTTCTCCAACTACTGGATCTCCTGGGTTCGTCAGGCTCCTGGTAAAGGTCTGGAATGGGTTGCTGAAATCCGTTCCGAATCCGACGCGTCCGCTACCCATTACGCTGAAGCTGTTAAAGGTCGTTTCACCATCTCCCGTGACAACGCTAAGAACTCCCTGTACCTGCAGATGAACTCCCTGCGTGCTGAAGACACCGCTGTTTACTACTGCCTGGCTTACTTTGACTACGGTCTGGCTATCCAGAACTACTGGGGTCAGGGTACCCTGGTTACCGTTTCCTCCGCCTCCACCAAGGGCCCATCTGTCTTCCCACTGGCCCCATGCTCCCGCAGCACCTCCGAGAGCACAGCCGCCCTGGGCTGCCTGGTCAAGGACTACTTCCCAGAACCTGTGACCGTGTCCTGGAACTCTGGCGCTCTGACCAGCGGCGTGCACACCTTCCCAGCTGTCCTGCAGTCCTCAGGTCTCTACTCCCTCAGCAGCGTGGTGACCGTGCCATCCAGCAACTTCGGCACCCAGACCTACACCTGCAACGTAGATCACAAGCCAAGCAACACCAAGGTCGACAAGACCGTGGAGAGAAAGTGTTGTGTGGAGTGTCCACCTTGTCCAGCCCCTCCAGTGGCCGGACCATCCGTGTTCCTGTTCCCTCCAAAGCCAAAGGACACCCTGATGATCTCCAGAACCCCAGAGGTGACCTGTGTGGTGGTGGACGTGTCCCACGAGGACCCAGAGGTGCAGTTCAACTGGTATGTGGACGGAGTGGAGGTGCACAACGCCAAGACCAAGCCAAGAGAGGAGCAGTTCAACTCCACCTTCAGAGTGGTGAGCGTGCTGACCGTGGTGCACCAGGACTGGCTGAACGGAAAGGAGTATAAGTGTAAGGTGTCCAACAAGGGACTGCCATCCAGCATCGAGAAGACCATCTCCAAGACCAAGGGACAGCCAAGAGAGCCACAGGTGTATACCCTGCCCCCATCCAGAGAGGAGATGACCAAGAACCAGGTGTCCCTGACCTGTCTGGTGAAGGGATTCTATCCATCCGACATCGCCGTGGAGTGGGAGTCCAACGGACAGCCAGAGAACAACTATAAGACCACCCCTCCAATGCTGGACTCCGACGGATCCTTCTTCCTGTATTCCAAGCTGACCGTGGACAAGTCCAGATGGCAGCAGGGAAACGTGTTCTCTTGTTCCGTGATGCACGAGGCCCTGCACAACCACTATACCCAGAAGAGCCTGTCCCTGTCTCCAGGAAAGTAAG1 light chain full antibody nucleotide sequence (SEQ ID NO: 14)GAAATCGTTCTGACCCAGTCCCCGGCTACCCTGTCCCTGTCCCCAGGTGAACGTGCTACCCTGTCCTGCAAAGCTTCCAAACGGGTTACCACCTACGTTTCCTGGTACCAGCAGAAACCCGGTCAGGCTCCTCGTCTGCTGATCTACGGTGCTTCCAACCGTTACCTCGGTATCCCAGCTCGTTTCTCCGGTTCCGGTTCCGGTACCGACTTCACCCTGACCATCTCCTCCCTGGAACCCGAAGACTTCGCTGTTTACTACTGCAGTCAGTCCTACAACTACCCCTACACCTTCGGTCAGGGTACCAAACTGGAAATCAAACGCACTGTGGCTGCACCATCTGTCTTCATCTTCCCTCCATCTGATGAGCAGTTGAAATCCGGAACTGCCTCTGTTGTGTGCCTGCTGAATAACTTCTATCCGCGCGAGGCCAAAGTACAGTGGAAGGTGGATAACGCCCTCCAATCCGGTAACTCCCAGGAGAGTGTCACAGAGCAGGACAGCAAGGACAGCACCTACAGCCTCAGCAGCACCCTGACCCTGAGCAAAGCAGACTACGAGAAACACAAAGTCTACGCCTGCGAAGTCACCCATCAGGGCCTGAGTTCTCCAGTCACAAAGAGCTTCAACCGCGGTGAGTGCTAAAmino acid sequence comparison of human and rat CGRP (humanα-CGRP (SEQ ID NO: 15); human β-CGRP (SEQ ID NO: 43);rat α-CGRP (SEQ ID NO: 41); and rat β-CGRP (SEQ ID NO: 44)): NH₂-AC

TATCVTHRLAGLLSRSGGVVK

NFVPTNVGSKAF-CONH₂ (human α-CGRP) NH₂-AC

TATCVTHRLAGLLSRSGG

VK

NFVPTNVGSKAF-CONH₂ (human β-CGRP) NH₂-

C

TATCVTHRLAGLLSRSGGVVK

NFVPTNVGS

AF-CONH₂ (rat α-CGRP) NH₂-

C

TATCVTHRLAGLLSRSGGVVK

FVPTNVGSKAF-CONH₂ (rat β-CGRP)Light chain variable region LCVR17 amino acid sequence (SEQ ID NO: 58)DIQMTQSPSSLSASVGDRVTITCRASQDIDNYLNWYQQKPGKAPKLLIYYTSEYHSGVPSRFSGSGSGTDFTFTISSLQPEDIATYYCQQGDALPPTFGQGTKLEIKHeavy chain variable region HCVR22 amino acid sequence (SEQ ID NO: 59)QVQLVQSGAEVKKPGASVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGDTRYIQKFAGRVTMTRDTSTSTVYMELSSLRSEDTAVYYCARLSDYVSGFSYWGQG TLVTVSSLight chain variable region LCVR18 amino acid sequence (SEQ ID NO: 60)DIQMTQSPSSLSASVGDRVTITCRASQDIDNYLNWYQQKPGKAPKLLIYYTSEYHSGVPSRFSGSGSGTDFTFTISSLQPEDIATYYCQQGDALPPTFGQGTKLEIKHeavy chain variable region HCVR23 amino acid sequence (SEQ ID NO: 61)QVQLVQSGAEVKKPGASVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFAGRVTMTRDTSTSTVYMELSSLRSEDTAVYYCARLSDYVSGFSYWGQG TLVTVSSLight chain variable region LCVR19 amino acid sequence (SEQ ID NO: 62)DIQMTQSPSSLSASVGDRVTITCRASKDISKYLNWYQQKPGKAPKLLIYYTSGYHSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQGDALPPTFGGGTKVEIKHeavy chain variable region HCVR24 amino acid sequence (SEQ ID NO: 63)QVQLVQSGAEVKKPGSSVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFADRVTITADKSTSTAYMELSSLRSEDTAVYYCARLSDYVSGFGYWGQGT TVTVSSLight chain variable region LCVR20 amino acid sequence (SEQ ID NO: 64)DIQMTQSPSSLSASVGDRVTITCRASRPIDKYLNWYQQKPGKAPKLLIYYTSEYHSGVPSRFSGSGSGTDFTFTISSLQPEDIATYYCQQGDALPPTFGQGTKLEIKHeavy chain variable region HCVR25 amino acid sequence (SEQ ID NO: 65)QVQLVQSGAEVKKPGASVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFAGRVTMTRDTSTSTVYMELSSLRSEDTAVYYCARLSDYVSGFGYWGQG TLVTVSSLight chain variable region LCVR21 amino acid sequence (SEQ ID NO: 66)DIQMTQSPSSLSASVGDRVTITCRASQDIDKYLNWYQQKPGKAPKLLIYYTSGYHSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQGDALPPTFGGGTKVEIKHeavy chain variable region HCVR26 amino acid sequence (SEQ ID NO: 67)QVQLVQSGAEVKKPGSSVKVSCKASGYTFGNYWMQWVRQAPGQGLEWMGAIYEGTGKTVYIQKFAGRVTITADKSTSTAYMELSSLRSEDTAVYYCARLSDYVSGFGYWGQGT TVTVSSLight chain variable region LCVR27 amino acid sequence (SEQ ID NO: 68)QVLTQSPSSLSASVGDRVTINCQASQSVYHNTYLAWYQQKPGKVPKQLIYDASTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCTNGDCFVFGGGTKVEIKRHeavy chain variable region HCVR28 amino acid sequence (SEQ ID NO: 69)EVQLVESGGGLVQPGGSLRLSCAVSGIDLSGYYMNWVRQAPGKGLEWVGVIGINGATYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSLight chain variable region LCVR29 amino acid sequence (SEQ ID NO: 70)QVLTQSPSSLSASVGDRVTINCQASQSVYDNNYLAWYQQKPGKVPKQLIYSTSTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCSSGDCFVFGGGTKVEIKRHeavy chain variable region HCVR30 amino acid sequence (SEQ ID NO: 71)EVQLVESGGGLVQPGGSLRLSCAVSGLDLSSYYMQWVRQAPGKGLEWVGVIGINDNTYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSLight chain variable region LCVR31 amino acid sequence (SEQ ID NO: 72)QVLTQSPSSLSASVGDRVTINCQASQSVYDNNYLAWYQQKPGKVPKQLIYSTSTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCSSGDCFVFGGGTKVEIKRHeavy chain variable region HCVR32 amino acid sequence (SEQ ID NO: 73)EVQLVESGGGLVQPGGSLRLSCAVSGLDLSSYYMQWVRQAPGKGLEWVGVIGINDNTYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSLight chain variable region LCVR33 amino acid sequence (SEQ ID NO: 74)QVLTQTPSPVSAAVGSTVTINCQASQSVYHNTYLAWYQQKPGQPPKQLIYDASTLASGVPSRFSGSGSGTQFTLTISGVQCNDAAAYYCLGSYDCTNGDCFVFGGGTEVVVKRHeavy chain variable region HCVR34 amino acid sequence (SEQ ID NO: 75)QSLEESGGRLVTPGTPLTLTCSVSGIDLSGYYMNWVRQAPGKGLEWIGVIGINGATYYASWAKGRFTISKTSSTTVDLKMTSLTTEDTATYFCARGDIWGPGTLVTVSSLight chain variable region LCVR35 amino acid sequence (SEQ ID NO: 76)QVLTQSPSSLSASVGDRVTINCQASQSVYHNTYLAWYQQKPGKVPKQLIYDASTLASGVPSRFSGSGSGTDFTLTISSLQPEDVATYYCLGSYDCTNGDCFVFGGGTKVEIKRHeavy chain variable region HCVR36 amino acid sequence (SEQ ID NO: 77)EVQLVESGGGLVQPGGSLRLSCAVSGIDLSGYYMNWVRQAPGKGLEWVGVIGINGATYYASWAKGRFTISRDNSKTTVYLQMNSLRAEDTAVYFCARGDIWGQGTLVTVSSLight chain variable region LCVR37 amino acid sequence (SEQ ID NO: 78)QSVLTQPPSVSAAPGQKVTISCSGSSSNIGNNYVSWYQQLPGTAPKLLIYDNNKRPSGIPDRFSGSKSGTSTTLGITGLQTGDEADYYCGTWDSRLSAVVFGGGTKLTVLHeavy chain variable region HCVR38 amino acid sequence (SEQ ID NO: 79)QVQLVESGGGVVQPGRSLRLSCAASGFTFSSFGMHWVRQAPGKGLEWVAVISFDGSIKYSVDSVKGRFTISRDNSKNTLFLQMNSLRAEDTAVYYCARDRLNYYDSSGYYHYKYYGMAVWGQGTTVTVSS

What is claimed is:
 1. A method of treating or preventing migraine in asubject having refractory migraine, the method comprising: selecting asubject who has been treated with two or more different preventativemigraine treatments wherein at least one of the preventative migrainetreatments is selected from topiramate, carbamazepine, divalproexsodium, sodium valproate, valproic acid, divalproex, flunarizine,candesartan, pizotifen, amitriptyline, venlafaxine, nortriptyline,duloxetine, atenolol, nadolol, metoprolol, propranolol, bisopropol,timolol, onabotulinumtoxin A, lisinopril, and oxeterone; andadministering to the subject a therapeutically effective amount of ahumanized monoclonal anti-calcitonin gene-related peptide (CGRP)antagonist antibody comprising the amino acid sequence of the heavychain variable region set forth in SEQ ID NO: 63 and the amino acidsequence of the light chain variable region set forth in SEQ ID NO: 62.2. The method of claim 1, wherein the subject has been treated with twoto four different preventative migraine treatments.
 3. The method ofclaim 1, wherein the at least one preventative migraine treatment isselected from propranolol, metoprolol, topiramate, divalproex sodium,sodium valproate, divalproex, valproic acid, amitriptyline, flunarizine,candesartan, and onabotulinumtoxin A.
 4. The method of claim 1, whereinthe at least one preventative migraine treatment is selected fromtopiramate, carbamazepine, divalproex sodium, sodium valproate,flunarizine, pizotifen, amitriptyline, venlafaxine, nortriptyline,duloxetine, atenolol, nadolol, metoprolol, propranolol, timolol, andonabotulinumtoxinA.
 5. The method of claim 1, wherein the at least onepreventative migraine treatment is selected from propranolol,metoprolol, topiramate, sodium valproate or divalproex, amitriptyline,flunarizine, candesartan, and onabotulinumtoxinA.
 6. The method of claim1, wherein each of the two or more preventative migraine treatments areselected from different groups (a)-(g): (a) propranolol or metoprolol,(b) topiramate, (c) sodium valproate or divalproex, (d) amitriptyline,(e) flunarizine, (f) candesartan, and (g) onabotulinumtoxinA.
 7. Themethod of claim 1, wherein each of the two or more preventative migrainetreatments are selected from different groups (a)-(e): (a) topiramate,(b) divalproex sodium or sodium valproate, (c) metoprolol, propranolol,timolol, atenolol, or nadolol, (d) amitriptyline or nortriptyline, and(e) venlafaxine or duloxetine.
 8. The method of claim 1, wherein thesubject has been treated with the two or more different preventativemigraine treatments within the 10 years prior to administering themonoclonal antibody.
 9. The method of claim 1, wherein the subject hasbeen diagnosed with episodic migraine prior to administering themonoclonal antibody.
 10. The method of claim 1, wherein the subject hasbeen diagnosed with chronic migraine prior to administering themonoclonal antibody.
 11. The method of claim 1, wherein the subjectexperiences migraines with aura.
 12. The method of claim 1, wherein thesubject experiences migraines without aura.
 13. The method of claim 1,wherein the monoclonal antibody is administered at a dose of about 100mg to about 500 mg.
 14. The method of claim 13, wherein the monoclonalantibody is administered at a dose of about 250 mg.
 15. The method ofclaim 14, wherein the dose of about 250 mg is administered as twoseparate injections of about 125 mg each.
 16. The method of claim 13,wherein the monoclonal antibody is administered at a dose of about 125mg.
 17. The method of claim 13, wherein the monoclonal antibody isadministered at a dose of about 250 mg followed by subsequent doses ofabout 125 mg at one month intervals.
 18. The method of claim 17, whereinthe dose of about 250 mg is administered as two separate injections ofabout 125 mg each.
 19. The method of claim 13, wherein the monoclonalantibody is administered once per month.
 20. The method of claim 1,wherein the monoclonal antibody is administered as a liquid formulationcomprising the monoclonal antibody at a concentration ranging from about10 mg/mL to about 250 mg/mL.
 21. The method of claim 1, wherein themonoclonal antibody is administered as a liquid formulation comprisingthe monoclonal antibody at a concentration of about 120 mg/mL.
 22. Themethod of claim 21, wherein the liquid formulation is administered at avolume of about 0.5 mL to about 2.5 mL.
 23. The method of claim 21,wherein the liquid formulation is administered at a volume of about 1mL.
 24. The method of claim 21, wherein the liquid formulation isadministered at a volume of about 2 mL.
 25. The method of claim 1,wherein the administering comprises administering the antibody to thesubject from a pre-filled syringe, pre-filled syringe with a needlesafety device, injection pen, or auto-injector comprising a dose of themonoclonal antibody.
 26. The method of claim 1, wherein monthly headachedays experienced by the subject after said administering is reduced bythree or more days from a pre-administration level in the subject. 27.The method of claim 1, comprising administering to the subject a secondagent simultaneously or sequentially with the monoclonal antibody,wherein the second agent is an acute headache medication.
 28. The methodof claim 27, wherein monthly use of the second agent by the subject isdecreased by at least 15% after administering the monoclonal antibody.29. The method of claim 1, wherein the monoclonal antibody isadministered subcutaneously.
 30. The method of claim 1, wherein themonoclonal antibody comprises the amino acid sequence of the heavy chainset forth in SEQ ID NO: 99, and the amino acid sequence of the lightchain set forth in SEQ ID NO: 98.